Provider Demographics
NPI:1154944775
Name:A GENTLE HAND RESIDENTIAL CARE
Entity type:Organization
Organization Name:A GENTLE HAND RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-797-7203
Mailing Address - Street 1:13052 COMPTON RD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4714
Mailing Address - Country:US
Mailing Address - Phone:561-797-7203
Mailing Address - Fax:561-795-3014
Practice Address - Street 1:808 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4400
Practice Address - Country:US
Practice Address - Phone:561-508-7994
Practice Address - Fax:561-508-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105771000Medicaid