Provider Demographics
NPI:1164512968
Name:VANCREST, LTD
Entity Type:Organization
Organization Name:VANCREST, LTD
Other - Org Name:VANCREST HEALTH CARE CENTER OF DELPHOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:EYANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-0715
Mailing Address - Street 1:1425 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9142
Mailing Address - Country:US
Mailing Address - Phone:419-695-2871
Mailing Address - Fax:419-692-0462
Practice Address - Street 1:1425 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9142
Practice Address - Country:US
Practice Address - Phone:419-695-2871
Practice Address - Fax:419-692-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5358314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2041445Medicaid
OH000000227781OtherANTHEM
OH2041445Medicaid