MEDICARE: FILLING MEMORIAL HOME OF MERCY, 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	315P00000X	Intellectual Disabilities Intermediate Care Facility	12966	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	:	1942207287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FILLING MEMORIAL HOME OF MERCY, INC.

Provider Business Mailing Address
First Line	:	N160 STATE ROUTE 108
Second Line	:
City	:	NAPOLEON
State	:	OH
Zip	:	43545-7729
Country	:	US
Telephone Number	:	419-592-6451
Fax Number	:	419-599-5178

Provider Business Practice Location Address
First Line	:	N160 STATE ROUTE 108
Second Line	:
City	:	NAPOLEON
State	:	OH
Zip	:	43545-7729
Country	:	US
Telephone Number	:	419-592-6451
Fax Number	:	419-599-5178

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL E. OEHRTMAN
Credential	:
Telephone Number	:	419-592-6451

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	08/22/2020

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