1790732576 NPI number — STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790732576 NPI number — STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING
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:
OHIO VETERANS HOME
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:
1790732576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3416 COLUMBUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44870-5557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-625-2454
Provider Business Mailing Address Fax Number:
419-609-2569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3416 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44870-5557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-625-2454
Provider Business Practice Location Address Fax Number:
419-609-2569
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIPTAY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR OF FISCAL OPERATIONS
Authorized Official Telephone Number:
419-625-2454

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  6341 , 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)





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