Provider Demographics
NPI:1619274909
Name:MAYFAIR VILLAGE NURSING CENTER
Entity Type:Organization
Organization Name:MAYFAIR VILLAGE NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-352-8692
Mailing Address - Street 1:3062 VISTA VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6922
Mailing Address - Country:US
Mailing Address - Phone:614-352-8692
Mailing Address - Fax:
Practice Address - Street 1:3062 VISTA VIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6922
Practice Address - Country:US
Practice Address - Phone:614-352-8692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136511314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility