Healthcare Provider Details

I. General information

NPI: 1962165886
Provider Name (Legal Business Name): ODEM AT AUGLAIZE OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13093 INFIRMARY RD
WAPAKONETA OH
45895-9325
US

IV. Provider business mailing address

1105 E COUNTY LINE RD STE 213
LAKEWOOD NJ
08701-2122
US

V. Phone/Fax

Practice location:
  • Phone: 419-738-3816
  • Fax:
Mailing address:
  • Phone:
  • 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: MENDY SEIDENFELD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 419-738-3816