Provider Demographics
NPI:1730522566
Name:GENTLE HEARTS HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:GENTLE HEARTS HOME HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUITO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-348-9594
Mailing Address - Street 1:2216 BALD EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4138
Mailing Address - Country:US
Mailing Address - Phone:972-348-9594
Mailing Address - Fax:972-213-1106
Practice Address - Street 1:2216 BALD EAGLE WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4138
Practice Address - Country:US
Practice Address - Phone:972-348-9594
Practice Address - Fax:972-213-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015781251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health