Provider Demographics
NPI:1932205952
Name:GENTLE HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:GENTLE HOME HEALTH CARE, LLC
Other - Org Name:GENTLE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDD
Authorized Official - Middle Name:LOWE
Authorized Official - Last Name:HUMPHERYS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:801-542-8450
Mailing Address - Street 1:9274 SOUTH 300 WEST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1436
Mailing Address - Country:US
Mailing Address - Phone:801-542-8450
Mailing Address - Fax:801-542-8453
Practice Address - Street 1:9274 SOUTH 300 WEST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1436
Practice Address - Country:US
Practice Address - Phone:801-542-8450
Practice Address - Fax:801-542-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1932205952Medicaid
UT467239Medicare Oscar/Certification