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General NPI Number Information
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NPI Number | 1770266066
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Entity Type | Organization
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Legal Business Name | THE BROOK OF GLADWIN, INC.
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 1201 W CEDAR AVE
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City | GLADWIN
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State | MI
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Zip | 48624-1873
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Country | US
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Telephone | 989-745-6500
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Fax | 989-745-6505
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Provider Business Mailing Address
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Address Line | PO BOX 649
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City | GRAYLING
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State | MI
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Zip | 49738-0649
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Country | US
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Telephone | 989-745-6500
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DIANE FRIEDRIECHSEN
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Credential |
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Telephone | 989-745-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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