Provider Demographics
NPI:1164016176
Name:GENTLEBROOK
Entity Type:Organization
Organization Name:GENTLEBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-7406
Mailing Address - Street 1:880 SUNNYSIDE ST SW
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9087
Mailing Address - Country:US
Mailing Address - Phone:330-877-7700
Mailing Address - Fax:
Practice Address - Street 1:640 MENLO PARK ST SW
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9698
Practice Address - Country:US
Practice Address - Phone:330-877-7700
Practice Address - Fax:330-877-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities