Provider Demographics
NPI:1093132326
Name:MARION MANOR NURSING HOME
Entity Type:Organization
Organization Name:MARION MANOR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVERING
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:740-397-8940
Mailing Address - Street 1:195 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6343
Mailing Address - Country:US
Mailing Address - Phone:740-387-9545
Mailing Address - Fax:740-382-3810
Practice Address - Street 1:195 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6343
Practice Address - Country:US
Practice Address - Phone:740-387-9545
Practice Address - Fax:740-382-3810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEVERING MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1473314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053847Medicaid
OH0053847Medicaid