MEDICARE: FILLING MEMORIAL HOME EGLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	24432	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9222	OTHER		ODH

General Provider Information

NPI Number	:	1053460485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FILLING MEMORIAL HOME EGLY

Provider Business Mailing Address
First Line	:	N 160 SB 108
Second Line	:
City	:	NAPOLEON
State	:	OH
Zip	:	43545-9363
Country	:	US
Telephone Number	:	419-592-6451
Fax Number	:	419-599-5178

Provider Business Practice Location Address
First Line	:	101 EGLY DRIVE
Second Line	:
City	:	WEST UNITY
State	:	OH
Zip	:	43570-9533
Country	:	US
Telephone Number	:	419-924-2806
Fax Number	:	419-924-2806

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. CAROL CECILIA SCHROEDER
Credential	:	MBOL
Telephone Number	:	419-592-6451

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2020

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Directions to “FILLING MEMORIAL HOME EGLY ” Practice Location

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