Provider Demographics
NPI:1669522405
Name:BRENTWOOD HEALTHCARE ENTERPRISES
Entity type:Organization
Organization Name:BRENTWOOD HEALTHCARE ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-468-2273
Mailing Address - Street 1:907 W AURORA RD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1605
Mailing Address - Country:US
Mailing Address - Phone:330-468-2273
Mailing Address - Fax:330-468-0753
Practice Address - Street 1:907 W AURORA RD
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-1605
Practice Address - Country:US
Practice Address - Phone:330-468-2273
Practice Address - Fax:330-468-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1906314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2339544Medicaid
OH365746Medicare UPIN