Provider Demographics
NPI:1326047929
Name:OHIO EASTERN STAR HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:OHIO EASTERN STAR HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:740-397-1706
Mailing Address - Street 1:1451 GAMBIER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9112
Mailing Address - Country:US
Mailing Address - Phone:740-397-1706
Mailing Address - Fax:740-392-1662
Practice Address - Street 1:1451 GAMBIER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9112
Practice Address - Country:US
Practice Address - Phone:740-397-1706
Practice Address - Fax:740-392-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274804Medicaid
OHOH00709OtherFACILITY ID
OH2064NOtherHCC #
OH36-6076Medicare ID - Type Unspecified
OH0274804Medicaid