Provider Demographics
NPI:1275520124
Name:GABLES AT GREEN PASTURES
Entity Type:Organization
Organization Name:GABLES AT GREEN PASTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MHA NHA
Authorized Official - Phone:937-578-4072
Mailing Address - Street 1:390 GABLES DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8358
Mailing Address - Country:US
Mailing Address - Phone:937-642-3893
Mailing Address - Fax:937-578-2480
Practice Address - Street 1:390 GABLES DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8358
Practice Address - Country:US
Practice Address - Phone:937-642-3893
Practice Address - Fax:937-578-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2226997Medicaid
OH2226997Medicaid
OH1209850001Medicare NSC