Provider Demographics
NPI:1609082742
Name:JAC-LIN MANOR
Entity Type:Organization
Organization Name:JAC-LIN MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SNOWBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-994-4191
Mailing Address - Street 1:695 S MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-1414
Mailing Address - Country:US
Mailing Address - Phone:419-994-5700
Mailing Address - Fax:
Practice Address - Street 1:695 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1414
Practice Address - Country:US
Practice Address - Phone:419-994-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities