=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447248927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEVERING MANAGEMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2005
-----------------------------------------------------
Last Update Date | 12/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 NORTH PORTLAND STREET
-----------------------------------------------------
City | FREDERICKTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43019-9378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-768-2401
-----------------------------------------------------
Fax | 419-768-9060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 44
-----------------------------------------------------
City | CHESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43317-0044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-768-2401
-----------------------------------------------------
Fax | 419-768-9060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DARLENE K YAKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-768-2401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 0754
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------