Provider Demographics
NPI:1992676993
Name:GUSTAVUS SENIOR CARE
Entity type:Organization
Organization Name:GUSTAVUS SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-876-6573
Mailing Address - Street 1:8785 YOUNGSTOWN KINGSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FARMDALE
Mailing Address - State:OH
Mailing Address - Zip Code:44417-9803
Mailing Address - Country:US
Mailing Address - Phone:330-355-7000
Mailing Address - Fax:
Practice Address - Street 1:8785 YOUNGSTOWN KINGSVILLE RD
Practice Address - Street 2:
Practice Address - City:FARMDALE
Practice Address - State:OH
Practice Address - Zip Code:44417-9803
Practice Address - Country:US
Practice Address - Phone:330-355-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty