Provider Demographics
NPI:1013159839
Name:LABRADOR CONSTRUCTION
Entity Type:Organization
Organization Name:LABRADOR CONSTRUCTION
Other - Org Name:TPC CONTRACTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLENWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-390-1115
Mailing Address - Street 1:627 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1908
Mailing Address - Country:US
Mailing Address - Phone:216-390-1115
Mailing Address - Fax:216-432-5757
Practice Address - Street 1:627 BISHOP RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1908
Practice Address - Country:US
Practice Address - Phone:216-390-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization