Healthcare Provider Details

I. General information

NPI: 1053460485
Provider Name (Legal Business Name): FILLING MEMORIAL HOME EGLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EGLY DRIVE
WEST UNITY OH
43570-9533
US

IV. Provider business mailing address

N 160 SB 108
NAPOLEON OH
43545-9363
US

V. Phone/Fax

Practice location:
  • Phone: 419-924-2806
  • Fax: 419-924-2806
Mailing address:
  • Phone: 419-592-6451
  • Fax: 419-599-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number24432
License Number StateOH

VIII. Authorized Official

Name: MS. CAROL CECILIA SCHROEDER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: MBOL
Phone: 419-592-6451