Provider Demographics
NPI:1598765174
Name:RV BRUNNER INC
Entity Type:Organization
Organization Name:RV BRUNNER INC
Other - Org Name:BRUNNER HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GIANCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-255-6786
Mailing Address - Street 1:8444 MENTOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5817
Mailing Address - Country:US
Mailing Address - Phone:440-255-6786
Mailing Address - Fax:440-255-7949
Practice Address - Street 1:8444 MENTOR AVENUE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5817
Practice Address - Country:US
Practice Address - Phone:440-255-6786
Practice Address - Fax:440-255-7949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RV BRUNNER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-26
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH43-031132332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1086506Medicaid
OH0247300001Medicare ID - Type Unspecified
OH1086506Medicaid