Provider Demographics
NPI:1508855735
Name:GENTLEBROOK HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:GENTLEBROOK HOME HEALTH SERVICES
Other - Org Name:HEALTH SERVICES OF COSHOCTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-622-7406
Mailing Address - Street 1:230 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2019
Mailing Address - Country:US
Mailing Address - Phone:740-622-7406
Mailing Address - Fax:740-622-7823
Practice Address - Street 1:230 S 4TH ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2019
Practice Address - Country:US
Practice Address - Phone:740-622-7311
Practice Address - Fax:740-845-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2183999Medicaid
OH2183999Medicaid