Provider Demographics
NPI:1497878102
Name:HEARTH & HOME AT VANDALIA
Entity Type:Organization
Organization Name:HEARTH & HOME AT VANDALIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-264-1140
Mailing Address - Street 1:55 GREAT HILL DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-1824
Mailing Address - Country:US
Mailing Address - Phone:937-264-1140
Mailing Address - Fax:937-264-1149
Practice Address - Street 1:55 GREAT HILL DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-1824
Practice Address - Country:US
Practice Address - Phone:937-264-1140
Practice Address - Fax:937-264-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2341RCF320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities