Healthcare Provider Details

I. General information

NPI: 1063403582
Provider Name (Legal Business Name): ZANDEX HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 FRIENDSHIP DR
NEW CONCORD OH
43762-1024
US

IV. Provider business mailing address

PO BOX 730 1122 TAYLOR STREET
ZANESVILLE OH
43702-0730
US

V. Phone/Fax

Practice location:
  • Phone: 740-872-0809
  • Fax: 740-826-9101
Mailing address:
  • Phone: 740-454-1400
  • Fax: 740-454-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5094
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2062N
License Number StateOH

VIII. Authorized Official

Name: MR. LYLE W CLARK
Title or Position: VP CFO
Credential: CFO
Phone: 740-454-1400