=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841846409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENTEEL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2019
-----------------------------------------------------
Last Update Date | 08/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 781 KAYNOR RD
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-8691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-929-4207
-----------------------------------------------------
Fax | 509-349-5055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 781 KAYNOR RD
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-8691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-929-4207
-----------------------------------------------------
Fax | 509-349-5055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EUGENE NASSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-929-4207
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------