Provider Demographics
NPI:1538142997
Name:HILTY MEMORIAL HOME
Entity Type:Organization
Organization Name:HILTY MEMORIAL HOME
Other - Org Name:HILTY HOME, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:VOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-358-1015
Mailing Address - Street 1:304 HILTY DR
Mailing Address - Street 2:P O BOX 359
Mailing Address - City:PANDORA
Mailing Address - State:OH
Mailing Address - Zip Code:45877-9476
Mailing Address - Country:US
Mailing Address - Phone:419-384-3218
Mailing Address - Fax:419-384-3217
Practice Address - Street 1:304 HILTY DR
Practice Address - Street 2:
Practice Address - City:PANDORA
Practice Address - State:OH
Practice Address - Zip Code:45877-9476
Practice Address - Country:US
Practice Address - Phone:419-384-3218
Practice Address - Fax:419-384-3217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNONITE HOME COMMUNITIES OF OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-21
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5316310400000X
OH4697313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386336Medicaid
OH366032Medicare ID - Type Unspecified
OH0386336Medicaid