1063403582 NPI number — ZANDEX HEALTH CARE CORPORATION

Table of content: (NPI 1063403582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063403582 NPI number — ZANDEX HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZANDEX HEALTH CARE CORPORATION
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:
BECKETT HOUSE AT NEW CONCORD
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:
1063403582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2017
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:
1280 FRIENDSHIP DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CONCORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43762-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-872-0809
Provider Business Practice Location Address Fax Number:
740-826-9101
Provider Enumeration Date:
11/03/2005

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:
740-454-1400

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  5094 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 2062N , 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: 5094 . This is a "FACILITY LICENSE NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0203943 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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