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General NPI Number Information
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NPI Number | 1851976658
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Entity Type | Organization
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Legal Business Name | VANCREST OF HICKSVILLE LLC
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 601 DEFIANCE AVE
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City | HICKSVILLE
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State | OH
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Zip | 43526
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Country | US
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Telephone | 419-238-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W MAIN ST STE 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 | CFO
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Name | EDGAR SILALAHI
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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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