Healthcare Provider Details

I. General information

NPI: 1053020685
Provider Name (Legal Business Name): ANTHONYS VILLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 PIERCE ST STE 306
SANDUSKY OH
44870-4669
US

IV. Provider business mailing address

PO BOX 337
SANDUSKY OH
44871-0337
US

V. Phone/Fax

Practice location:
  • Phone: 567-290-2658
  • Fax:
Mailing address:
  • Phone: 567-290-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHELLE WESTERN
Title or Position: EXECUTIVE DIRECTOR
Credential: LISW-S
Phone: 567-290-2658