Provider Demographics
NPI:1780941484
Name:CHARLES E. GARRETT JR
Entity type:Organization
Organization Name:CHARLES E. GARRETT JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:937-520-0395
Mailing Address - Street 1:2351 WIENBURG DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-7944
Mailing Address - Country:US
Mailing Address - Phone:937-520-0395
Mailing Address - Fax:
Practice Address - Street 1:2351 WIENBURG DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-7944
Practice Address - Country:US
Practice Address - Phone:937-520-0395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400598840307314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility