Basic Information
| Provider Information | |||||||||
| NPI: | 1255728762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUMLEY | ||||||||
| FirstName: | JASON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 CUSTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SARDINIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45171 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 HALE ST | ||||||||
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| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451772104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373821621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OT.006816 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.