Provider Demographics
NPI:1073080644
Name:GENTEEL, LLC
Entity Type:Organization
Organization Name:GENTEEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TO THE CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:503-534-3107
Mailing Address - Street 1:333 S STATE ST STE V432
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3932
Mailing Address - Country:US
Mailing Address - Phone:503-534-3107
Mailing Address - Fax:503-675-0564
Practice Address - Street 1:2904 RAWHIDE ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2313
Practice Address - Country:US
Practice Address - Phone:503-534-3107
Practice Address - Fax:503-675-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies