Healthcare Provider Details

I. General information

NPI: 1073714168
Provider Name (Legal Business Name): COUNTRY VIEW HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COUNTRY VIEW HAVEN R858 CO RD 15
NAPOLEON OH
43545
US

IV. Provider business mailing address

P.O. BOX 525 R-858 CO RD 15
NAPOLEON OH
43545
US

V. Phone/Fax

Practice location:
  • Phone: 419-592-8075
  • Fax: 419-592-6620
Mailing address:
  • Phone: 419-592-8075
  • Fax: 419-592-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: SUE MEISTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 419-592-8075