MEDICARE: VIENNA ENTERPRISES INC

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	613	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	613	OTHER	OH	NURSING HOME LICENSE

General Provider Information

NPI Number	:	1306907324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIENNA ENTERPRISES INC

Provider Business Mailing Address
First Line	:	125 EAST NATIONAL ROAD
Second Line	:
City	:	S. VIENNA
State	:	OH
Zip	:	45369-0447
Country	:	US
Telephone Number	:	937-568-4342
Fax Number	:	937-568-4265

Provider Business Practice Location Address
First Line	:	125 EAST NATIONAL ROAD
Second Line	:
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-0447
Country	:	US
Telephone Number	:	937-568-4342
Fax Number	:	937-568-4265

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARK ROBERT WARNER
Credential	:	NHA
Telephone Number	:	937-568-4342

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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