Ghac3 Niles Mi Alf TRS Sub LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

GHAC3 NILES MI ALF TRS SUB LLC

Doing business as

Brentwood of Niles Senior Living

Practice address

1147 S 3Rd St
Niles, MI 49120-3472

Phone

(269) 684-9470

NPI assigned

May 23, 2023

Last updated

May 23, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tammy Gerardot

Title

Sr Directo of Compliance & Revenue

Phone

(260) 414-5085

Specialties & licenses 1

Addresses

Other names 1

• Brentwood of Niles Senior Living Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684800000000",
    "number": "1639861297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 CHESTNUT HILLS PKWY STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468148728",
            "telephone_number": "260-414-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 S 3RD ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491203472",
            "telephone_number": "269-684-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GHAC3 NILES MI ALF TRS SUB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A",
        "authorized_official_last_name": "GERARDOT",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "SR DIRECTO OF COMPLIANCE & REVENUE",
        "authorized_official_telephone_number": "260-414-5085"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brentwood of Niles Senior Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glenda M Gensolin, MD
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• Kristine Elizabeth Gervasi, LLPC
• Tsion Getahun
• Giva Tillman-Adkins (All Needs Senior Services)
• Lori F Glass, O.D.
• GLC Home Health Swmi LLC (Elara Caring)
• Glenda M Gensolin MD PLLC
• Antonio Ray Gonzales, D.C.

• Nursing Care Agency in Niles, MI
• Providers in Niles, MI by specialty
• Nursing Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.