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General NPI Number Information
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NPI Number | 1609082742
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Entity Type | Organization
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Legal Business Name | JAC-LIN MANOR
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 695 S MOUNT VERNON AVE
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City | LOUDONVILLE
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State | OH
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Zip | 44842-1414
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Country | US
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Telephone | 419-994-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 695 S MOUNT VERNON AVE
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City | LOUDONVILLE
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State | OH
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Zip | 44842-1414
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Country | US
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Telephone | 419-994-5700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LINDA S. SNOWBARGER
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Credential |
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Telephone | 419-994-4191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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