MEDICARE: THE SARAH JANE LIVING CENTER 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	313M00000X	Nursing Facility/Intermediate Care Facility	5862	OH
2	314000000X	Skilled Nursing Facility	2296N	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	:	1912095993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SARAH JANE LIVING CENTER LTD

Provider Business Mailing Address
First Line	:	120 W MAIN ST
Second Line	:	SUITE 200
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	:	328 WEST SECOND STREET
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833
Country	:	US
Telephone Number	:	419-692-6618
Fax Number	:	419-692-2654

Authorized Official
Title or Position	:	CFO
Name	:	MR. MARK STUART MCCLEERY
Credential	:	CPA
Telephone Number	:	419-238-0715

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	12/05/2016

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Directions to “THE SARAH JANE LIVING CENTER LTD ” Practice Location

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