Provider Demographics
NPI:1588317002
Name:GENTLE GUARDIANS LLC
Entity type:Organization
Organization Name:GENTLE GUARDIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAVIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-224-1095
Mailing Address - Street 1:2400 W 102ND ST APT 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3359
Mailing Address - Country:US
Mailing Address - Phone:612-203-4535
Mailing Address - Fax:952-456-6250
Practice Address - Street 1:2400 W 102ND ST APT 101
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3359
Practice Address - Country:US
Practice Address - Phone:612-203-4535
Practice Address - Fax:952-456-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health