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General NPI Number Information
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NPI Number | 1497926489
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Entity Type | Organization
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Legal Business Name | VANCREST OF URBANA, INC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 2380 S US HIGHWAY 68
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City | URBANA
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State | OH
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Zip | 43078-9470
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Country | US
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Telephone | 937-653-5291
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Fax | 937-653-3885
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Provider Business Mailing Address
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Address Line | 120 W MAIN ST SUITE 200
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City | VAN WERT
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State | OH
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Zip | 45891-1761
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Country | US
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Telephone | 419-238-0715
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Fax | 419-238-4814
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JON D. BAGLEY
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Credential |
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Telephone | 419-238-0715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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