Provider Demographics
NPI:1497926489
Name:VANCREST OF URBANA, INC
Entity Type:Organization
Organization Name:VANCREST OF URBANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-0715
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1761
Mailing Address - Country:US
Mailing Address - Phone:419-238-0715
Mailing Address - Fax:419-238-4814
Practice Address - Street 1:2380 S US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9470
Practice Address - Country:US
Practice Address - Phone:937-653-5291
Practice Address - Fax:937-653-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2900687Medicaid
OH2900687Medicaid