Provider Demographics
NPI:1053598532
Name:GENTLE HANDS HOME HEATHCARE SERVICES, LLC
Entity type:Organization
Organization Name:GENTLE HANDS HOME HEATHCARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:ELLIS EL
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MS
Authorized Official - Phone:757-495-1451
Mailing Address - Street 1:810 KEMPSVILLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2723
Mailing Address - Country:US
Mailing Address - Phone:757-495-1451
Mailing Address - Fax:757-495-1453
Practice Address - Street 1:810 KEMPSVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:VIRGINIA BCH
Practice Address - State:VA
Practice Address - Zip Code:23464-2723
Practice Address - Country:US
Practice Address - Phone:757-495-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-27
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPORTSMOUTH23251E00000X, 251G00000X
VAPORTSMOUTH251J00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPORTSMOUTH23Medicaid
VAPORTSMOUTH23Medicare PIN
VAPORTSMOUTH23Medicare UPIN
VAPORTSMOUTH23Medicare Oscar/Certification