Provider Demographics
NPI:1437146149
Name:BRENN-FIELD NURSING CENTER INC.
Entity Type:Organization
Organization Name:BRENN-FIELD NURSING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-683-4075
Mailing Address - Street 1:1980 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-2337
Mailing Address - Country:US
Mailing Address - Phone:330-683-4075
Mailing Address - Fax:330-683-4414
Practice Address - Street 1:1980 LYNN DR
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2337
Practice Address - Country:US
Practice Address - Phone:330-683-4075
Practice Address - Fax:330-683-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2376314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0250419Medicaid
OH000000305694OtherBCBS PROVIDER NUMBER
OH366123Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER