Provider Demographics
NPI:1245203579
Name:COUNTY OF AUGLAIZE OFFICE OF COUNTY AUDITOR
Entity Type:Organization
Organization Name:COUNTY OF AUGLAIZE OFFICE OF COUNTY AUDITOR
Other - Org Name:AUGLAIZE ACRES NURSING HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUDHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:419-738-3816
Mailing Address - Street 1:13093 INFIRMARY RD
Mailing Address - Street 2:COUNTY OF AUGLAIZE OFFICE OF COUNTY AUDITOR;
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9325
Mailing Address - Country:US
Mailing Address - Phone:419-738-3816
Mailing Address - Fax:419-738-6684
Practice Address - Street 1:13093 INFIRMARY RD
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9325
Practice Address - Country:US
Practice Address - Phone:419-738-3816
Practice Address - Fax:419-738-6684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0318847Medicaid
OH0318847Medicaid