Provider Demographics
NPI:1275524480
Name:HOLZER SENIOR CARE CENTER
Entity Type:Organization
Organization Name:HOLZER SENIOR CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-288-0192
Mailing Address - Street 1:380 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9215
Mailing Address - Country:US
Mailing Address - Phone:740-446-5001
Mailing Address - Fax:740-441-1347
Practice Address - Street 1:380 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9215
Practice Address - Country:US
Practice Address - Phone:740-446-5001
Practice Address - Fax:740-441-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4969314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0139693Medicaid
OH365998Medicare ID - Type Unspecified