Provider Demographics
NPI:1497822100
Name:BROOKESIDE AMBULETTE, INC.
Entity Type:Organization
Organization Name:BROOKESIDE AMBULETTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTOWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-269-1660
Mailing Address - Street 1:255 GRADOLPH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1461
Mailing Address - Country:US
Mailing Address - Phone:419-269-1660
Mailing Address - Fax:419-269-1154
Practice Address - Street 1:255 GRADOLPH ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1461
Practice Address - Country:US
Practice Address - Phone:419-269-1660
Practice Address - Fax:419-269-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH485055343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0963159Medicaid