Provider Demographics
NPI:1437252194
Name:ECHO MANOR EXTENDED CARE FACILITY
Entity Type:Organization
Organization Name:ECHO MANOR EXTENDED CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:NIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-864-1718
Mailing Address - Street 1:10270 BLACKLICK EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9225
Mailing Address - Country:US
Mailing Address - Phone:614-864-1718
Mailing Address - Fax:614-864-2313
Practice Address - Street 1:10270 BLACKLICK EASTERN RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9225
Practice Address - Country:US
Practice Address - Phone:614-864-1718
Practice Address - Fax:614-864-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0467418Medicaid
OH0467418Medicaid