Provider Demographics
NPI:1093404857
Name:VANCREST OF UPPER SANDUSKY LLC
Entity Type:Organization
Organization Name:VANCREST OF UPPER SANDUSKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-0715
Mailing Address - Street 1:850 MARSEILLES AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1648
Mailing Address - Country:US
Mailing Address - Phone:419-294-4973
Mailing Address - Fax:419-294-4975
Practice Address - Street 1:850 MARSEILLES AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1648
Practice Address - Country:US
Practice Address - Phone:419-294-4973
Practice Address - Fax:419-294-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1116NOtherLICENSURE