MEDICARE: VIENNA CARE CENTER, INC.

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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1194086439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIENNA CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	70 PARK AVE W
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44902-1624
Country	:	US
Telephone Number	:	419-529-7272
Fax Number	:	419-522-2040

Provider Business Practice Location Address
First Line	:	125 E NATIONAL RD
Second Line	:
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-9742
Country	:	US
Telephone Number	:	937-568-4542
Fax Number	:	877-448-6532

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL J BUNNER
Credential	:
Telephone Number	:	419-529-7272

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	06/13/2012

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