Provider Demographics
NPI:1376286500
Name:KUTCHBACK, BRENT CHARLES
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:CHARLES
Last Name:KUTCHBACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 BOOKMARK PL
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9516
Mailing Address - Country:US
Mailing Address - Phone:513-476-5100
Mailing Address - Fax:
Practice Address - Street 1:3500 BOOKMARK PL
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9516
Practice Address - Country:US
Practice Address - Phone:513-476-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care