Healthcare Provider Details

I. General information

NPI: 1477479632
Provider Name (Legal Business Name): VANCREST OF UPPER SANDUSKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MARSEILLES AVE
UPPER SANDUSKY OH
43351-1648
US

IV. Provider business mailing address

120 W MAIN ST STE 200
VAN WERT OH
45891-1761
US

V. Phone/Fax

Practice location:
  • Phone: 419-294-4973
  • Fax:
Mailing address:
  • Phone: 419-238-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EDGAR SILALAHI
Title or Position: CFO
Credential:
Phone: 567-712-9002