Healthcare Provider Details

I. General information

NPI: 1669471264
Provider Name (Legal Business Name): THE OHIO EASTERN STAR HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 GAMBIER RD
MOUNT VERNON OH
43050-9112
US

IV. Provider business mailing address

1451 GAMBIER RD
MOUNT VERNON OH
43050-9112
US

V. Phone/Fax

Practice location:
  • Phone: 740-397-1706
  • Fax: 740-392-1662
Mailing address:
  • Phone: 740-397-1706
  • Fax: 740-392-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number190
License Number StateOH

VIII. Authorized Official

Name: MRS. ZANDRA LEIGH SMITH
Title or Position: CEO/ADMINISTRATOR
Credential: LNHA
Phone: 740-397-1706