Provider Demographics
NPI:1588894091
Name:GENTLE HANDS HOME SERVICES LL.C.
Entity type:Organization
Organization Name:GENTLE HANDS HOME SERVICES LL.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-506-4136
Mailing Address - Street 1:3504 HYANNIS PORT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-1214
Mailing Address - Country:US
Mailing Address - Phone:317-506-4136
Mailing Address - Fax:317-299-9166
Practice Address - Street 1:3504 HYANNIS PORT DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-1214
Practice Address - Country:US
Practice Address - Phone:317-506-4136
Practice Address - Fax:317-299-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN253Z00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care