Provider Demographics
NPI:1083402903
Name:GENTLE GUARDIAN SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:GENTLE GUARDIAN SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIMO
Authorized Official - Middle Name:ABDIKARIM
Authorized Official - Last Name:SAHIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-617-5167
Mailing Address - Street 1:3919 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64117-2235
Mailing Address - Country:US
Mailing Address - Phone:816-617-5167
Mailing Address - Fax:
Practice Address - Street 1:3919 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117-2235
Practice Address - Country:US
Practice Address - Phone:816-617-5167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty