MEDICARE: VANCREST, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	5358	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000227781	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1164512968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANCREST, LTD

Provider Business Mailing Address
First Line	:	120 W MAIN ST STE 200
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-1761
Country	:	US
Telephone Number	:	419-238-0715
Fax Number	:	419-238-4814

Provider Business Practice Location Address
First Line	:	1425 E 5TH ST
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9142
Country	:	US
Telephone Number	:	419-695-2871
Fax Number	:	419-692-0462

Authorized Official
Title or Position	:	ASST CFO
Name	:	KYLE HOLLIDAY
Credential	:
Telephone Number	:	419-238-0715

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	05/19/2026

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Directions to “VANCREST, LTD ” Practice Location

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