Provider Demographics
NPI:1114932852
Name:MARY SCOTT NURSING HOME, INC.
Entity Type:Organization
Organization Name:MARY SCOTT NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-278-0761
Mailing Address - Street 1:3109 CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406
Mailing Address - Country:US
Mailing Address - Phone:937-278-0761
Mailing Address - Fax:937-278-6482
Practice Address - Street 1:3109 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406
Practice Address - Country:US
Practice Address - Phone:937-278-0761
Practice Address - Fax:937-278-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4241314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120210Medicaid
OH366122Medicare Oscar/Certification
OH1162540001Medicare NSC