Provider Demographics
NPI:1447302195
Name:GENTLE CARE HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:GENTLE CARE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:TEODORO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:734-243-3134
Mailing Address - Street 1:15305 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2693
Mailing Address - Country:US
Mailing Address - Phone:734-246-3134
Mailing Address - Fax:734-246-3641
Practice Address - Street 1:15305 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2693
Practice Address - Country:US
Practice Address - Phone:734-246-3134
Practice Address - Fax:734-246-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237470251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4451485Medicaid
MI0E934OtherBLUE CROSS BLUE SHIELD
MI4451485Medicaid