Provider Demographics
NPI:1144470634
Name:TONI GAMBLE
Entity type:Organization
Organization Name:TONI GAMBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICTIO
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:TEKILA
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:216-441-4585
Mailing Address - Street 1:3545 E 105TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-1815
Mailing Address - Country:US
Mailing Address - Phone:216-441-4585
Mailing Address - Fax:
Practice Address - Street 1:3545 E 105TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-1815
Practice Address - Country:US
Practice Address - Phone:216-441-4585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130161320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities