Provider Demographics
NPI:1962908905
Name:GENTLE SHEPHERD HOME CARE LLC
Entity type:Organization
Organization Name:GENTLE SHEPHERD HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-359-8371
Mailing Address - Street 1:1271 KELLY JOHNSON BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3962
Mailing Address - Country:US
Mailing Address - Phone:719-359-8371
Mailing Address - Fax:719-424-7178
Practice Address - Street 1:1271 KELLY JOHNSON BLVD STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3962
Practice Address - Country:US
Practice Address - Phone:719-359-8371
Practice Address - Fax:719-424-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04K180253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care