Provider Demographics
NPI:1487429361
Name:C GENTLE SERVICES
Entity type:Organization
Organization Name:C GENTLE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-985-1261
Mailing Address - Street 1:2950 SW BOXWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6967
Mailing Address - Country:US
Mailing Address - Phone:772-985-1261
Mailing Address - Fax:
Practice Address - Street 1:1860 SW FOUNTAINVIEW BLVD, SUITE 200
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:772-985-1261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C GENTLE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory