Provider Demographics
NPI:1194042150
Name:GENTLE LOVE HOME SERVICES
Entity type:Organization
Organization Name:GENTLE LOVE HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-739-3352
Mailing Address - Street 1:19940 CONANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1335
Mailing Address - Country:US
Mailing Address - Phone:313-739-3352
Mailing Address - Fax:
Practice Address - Street 1:19940 CONANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1335
Practice Address - Country:US
Practice Address - Phone:313-739-3352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health