MEDICARE: ERIE COUNTY OFFICE OF AUDITOR

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	313M00000X	Nursing Facility/Intermediate Care Facility		OH
2	314000000X	Skilled Nursing Facility		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

General Provider Information

NPI Number	:	1881681054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIE COUNTY OFFICE OF AUDITOR

Provider Business Mailing Address
First Line	:	3916 PERKINS AVE
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1059
Country	:	US
Telephone Number	:	419-627-8733
Fax Number	:	419-627-1614

Provider Business Practice Location Address
First Line	:	3916 PERKINS AVE
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1059
Country	:	US
Telephone Number	:	419-627-8733
Fax Number	:	419-627-1614

Authorized Official
Title or Position	:	ASST ADMINISTRATOR/DON
Name	:	DONNA PATRICK
Credential	:	RN
Telephone Number	:	419-627-8733

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	09/28/2017

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Directions to “ERIE COUNTY OFFICE OF AUDITOR ” Practice Location

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