Provider Demographics
NPI:1023826070
Name:GENTLE GUARDIAN HOME CARE LLC
Entity type:Organization
Organization Name:GENTLE GUARDIAN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:743-258-8604
Mailing Address - Street 1:4203 QUEEN BETH DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6360
Mailing Address - Country:US
Mailing Address - Phone:743-258-8604
Mailing Address - Fax:336-285-8554
Practice Address - Street 1:4203 QUEEN BETH DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6360
Practice Address - Country:US
Practice Address - Phone:743-258-8604
Practice Address - Fax:336-285-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care