Provider Demographics
NPI:1396236048
Name:GENTLE LOVE AND CARE ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:GENTLE LOVE AND CARE ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-292-6563
Mailing Address - Street 1:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-1782
Mailing Address - Country:US
Mailing Address - Phone:386-292-6563
Mailing Address - Fax:866-462-5823
Practice Address - Street 1:1001 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-8915
Practice Address - Country:US
Practice Address - Phone:386-292-6563
Practice Address - Fax:866-462-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness