MEDICARE: IHS ACQUISITION NO 125 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	314000000X	Skilled Nursing Facility	5464	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

General Provider Information

NPI Number	:	1538146212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHS ACQUISITION NO 125 INC

Provider Business Mailing Address
First Line	:	76 HIGH ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-9308
Country	:	US
Telephone Number	:	830-869-2015
Fax Number	:	330-769-3790

Provider Business Practice Location Address
First Line	:	76 HIGH ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-9308
Country	:	US
Telephone Number	:	830-869-2015
Fax Number	:	330-769-3790

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN REYNOLDS
Credential	:
Telephone Number	:	410-513-8738

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/16/2014

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