1215086640 NPI number — FILLING MEMORIAL HOME CARDINAL

Table of content: (NPI 1215086640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215086640 NPI number — FILLING MEMORIAL HOME CARDINAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FILLING MEMORIAL HOME CARDINAL
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:
Provider Other Organization Name Type Code:
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:
1215086640
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:
N 160 SR 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPOLEON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43545-9362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-592-6451
Provider Business Mailing Address Fax Number:
419-599-5178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 CARDINAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-636-2369
Provider Business Practice Location Address Fax Number:
419-636-2869
Provider Enumeration Date:
01/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHROEDER
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
CECILIA
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
419-592-6451

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  24806 , 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: 2361457 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9144 . This is a "ODH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".