Provider Demographics
NPI:1770266066
Name:THE BROOK OF GLADWIN, INC.
Entity type:Organization
Organization Name:THE BROOK OF GLADWIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDRIECHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-745-6500
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-0649
Mailing Address - Country:US
Mailing Address - Phone:989-745-6500
Mailing Address - Fax:
Practice Address - Street 1:1201 W CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1873
Practice Address - Country:US
Practice Address - Phone:989-745-6500
Practice Address - Fax:989-745-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility