Provider Demographics
NPI:1285729376
Name:1ST GENTLECARE HOME HEALTH, LLC
Entity type:Organization
Organization Name:1ST GENTLECARE HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MBANWITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-636-4483
Mailing Address - Street 1:1901 CENTRAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5825
Mailing Address - Country:US
Mailing Address - Phone:214-905-1414
Mailing Address - Fax:214-905-3441
Practice Address - Street 1:1901 CENTRAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5825
Practice Address - Country:US
Practice Address - Phone:214-905-1414
Practice Address - Fax:214-905-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010077251E00000X
251F00000X, 253Z00000X, 3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679542Medicare PIN
TX679542Medicare Oscar/Certification