MEDICARE: JAC-LIN MANOR

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1609082742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAC-LIN MANOR

Provider Business Mailing Address
First Line	:	695 S MOUNT VERNON AVE
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1414
Country	:	US
Telephone Number	:	419-994-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 S MOUNT VERNON AVE
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1414
Country	:	US
Telephone Number	:	419-994-5700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LINDA S. SNOWBARGER
Credential	:
Telephone Number	:	419-994-4191

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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Directions to “JAC-LIN MANOR ” Practice Location

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