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General NPI Number Information
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NPI Number | 1831216688
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Entity Type | Organization
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Legal Business Name | WHITEHOUSE COUNTRY MANOR
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11239 WATERVILLE ST
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City | WHITEHOUSE
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State | OH
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Zip | 43571-9813
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Country | US
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Telephone | 419-877-5338
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Fax | 419-877-1049
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Provider Business Mailing Address
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Address Line | 11239 WATERVILLE ST
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City | WHITEHOUSE
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State | OH
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Zip | 43571-9813
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Country | US
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Telephone | 419-877-5338
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Fax | 419-877-1049
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. DEBRA S TOWNSEND
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Credential |
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Telephone | 419-877-5338
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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 | 1698N
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License Number State | OH
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