MEDICARE: VANCREST OF NEW CARLISLE

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	310400000X	Assisted Living Facility	2553R	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	:	1992040497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANCREST OF NEW CARLISLE

Provider Business Mailing Address
First Line	:	120 W MAIN ST STE 200
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-1761
Country	:	US
Telephone Number	:	419-238-0715
Fax Number	:	419-238-4814

Provider Business Practice Location Address
First Line	:	1885 N DAYTON LAKEVIEW RD
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-8292
Country	:	US
Telephone Number	:	937-845-8219
Fax Number	:	937-845-2404

Authorized Official
Title or Position	:	ASST CFO
Name	:	KYLE HOLLIDAY
Credential	:
Telephone Number	:	419-238-0715

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	05/19/2026

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Directions to “VANCREST OF NEW CARLISLE ” Practice Location

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