Provider Demographics
NPI:1164394979
Name:GENTLE GLOW HOME CARE AGENCY
Entity type:Organization
Organization Name:GENTLE GLOW HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-212-0132
Mailing Address - Street 1:17475 JOVANNA DR STE 151A
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4679
Mailing Address - Country:US
Mailing Address - Phone:800-914-8590
Mailing Address - Fax:
Practice Address - Street 1:17475 JOVANNA DR STE 151A
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4679
Practice Address - Country:US
Practice Address - Phone:800-914-8590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No283XC2000XHospitalsRehabilitation HospitalChildren
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child