1053460485 NPI number — FILLING MEMORIAL HOME EGLY

Table of content: (NPI 1053460485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053460485 NPI number — FILLING MEMORIAL HOME EGLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FILLING MEMORIAL HOME EGLY
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:
1053460485
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 SB 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:
43545-9363
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:
101 EGLY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST UNITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43570-9533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-924-2806
Provider Business Practice Location Address Fax Number:
419-924-2806
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:  24432 , 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: 0361439 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9222 . This is a "ODH" identifier . This identifiers is of the category "OTHER".




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