Provider Demographics
NPI:1780971762
Name:GENTLEBROOK, INC.
Entity type:Organization
Organization Name:GENTLEBROOK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SLEUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-877-7700
Mailing Address - Street 1:880 SUNNYSIDE ST SW
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9087
Mailing Address - Country:US
Mailing Address - Phone:330-877-7700
Mailing Address - Fax:330-877-7701
Practice Address - Street 1:880 SUNNYSIDE ST SW
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9087
Practice Address - Country:US
Practice Address - Phone:330-877-7700
Practice Address - Fax:330-877-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH7601796320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274140Medicaid