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General NPI Number Information
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NPI Number | 1144241324
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Entity Type | Organization
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Legal Business Name | THE OHIO MASONIC HOME
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 4931 NETTLETON RD
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City | MEDINA
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State | OH
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Zip | 44256-3232
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Country | US
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Telephone | 330-721-3000
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Fax | 330-721-3279
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Provider Business Mailing Address
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Address Line | PO BOX 120
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City | SPRINGFIELD
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State | OH
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Zip | 45501-0120
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Country | US
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Telephone | 937-525-3048
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Fax | 937-525-8302
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Authorized Official
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Title or Position | CFO
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Name | MR. SCOTT BUCHANAN
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Credential |
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Telephone | 937-525-4975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 6114
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 6113
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License Number State | OH
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