Healthcare Provider Details

I. General information

NPI: 1912922584
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA CARE FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 S MUMAUGH RD
LIMA OH
45804-3569
US

IV. Provider business mailing address

7485 OFFICE RIDGE CIR
EDEN PRAIRIE MN
55344-3690
US

V. Phone/Fax

Practice location:
  • Phone: 419-225-9040
  • Fax: 419-225-9292
Mailing address:
  • Phone: 952-941-0305
  • Fax: 952-941-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number6106
License Number StateOH

VIII. Authorized Official

Name: MR. NANCY GAVIN
Title or Position: ASSISTANT SECRETARY/TREASURER
Credential:
Phone: 952-941-0305