Healthcare Provider Details

I. General information

NPI: 1114932852
Provider Name (Legal Business Name): MARY SCOTT NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 CAMPUS DRIVE
DAYTON OH
45406
US

IV. Provider business mailing address

3109 CAMPUS DRIVE
DAYTON OH
45406
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-0761
  • Fax: 937-278-6482
Mailing address:
  • Phone: 937-278-0761
  • Fax: 937-278-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4241
License Number StateOH

VIII. Authorized Official

Name: MS. SUE D. DUCKER
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 937-278-0761