Provider Demographics
NPI:1043217011
Name:MEIGS COUNTY CARE CENTER, LLC
Entity Type:Organization
Organization Name:MEIGS COUNTY CARE CENTER, LLC
Other - Org Name:OVERBROOK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:740-992-6472
Mailing Address - Street 1:333 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:45760-1391
Mailing Address - Country:US
Mailing Address - Phone:740-992-6472
Mailing Address - Fax:740-992-7406
Practice Address - Street 1:333 PAGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:OH
Practice Address - Zip Code:45760-1391
Practice Address - Country:US
Practice Address - Phone:740-992-6472
Practice Address - Fax:740-992-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0740041Medicaid
OH365721Medicare ID - Type UnspecifiedPROVIDER NUMBER