1124184924 NPI number — THE CHAMPAIGN COUNTY BOARD OF COMMISSIONERS

Table of content: (NPI 1124184924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124184924 NPI number — THE CHAMPAIGN COUNTY BOARD OF COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHAMPAIGN COUNTY BOARD OF COMMISSIONERS
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:
THE WELLINGTON NURSING AND REHABILITATION 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:
1124184924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2380 S US HIGHWAY 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43078-9470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-653-5291
Provider Business Mailing Address Fax Number:
937-653-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2380 S US HIGHWAY 68
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43078-9470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-653-5291
Provider Business Practice Location Address Fax Number:
937-653-3885
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALDWELL
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
937-653-5291

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0250400 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2684126 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2655532 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0566258 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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