1326035130 NPI number — ZANDEX HEALTH CARE CORP

Table of content: (NPI 1326035130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326035130 NPI number — ZANDEX HEALTH CARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZANDEX HEALTH CARE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CEDAR HILL CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326035130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 730
Provider Second Line Business Mailing Address:
1122 TAYLOR STREET
Provider Business Mailing Address City Name:
ZANESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43702-0730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-454-1400
Provider Business Mailing Address Fax Number:
740-454-7439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1136 ADAIR AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-454-6823
Provider Business Practice Location Address Fax Number:
740-454-6167
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
LYLE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
VP CFO
Authorized Official Telephone Number:
740-588-2154

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1770N , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0524543 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com