Provider Demographics
NPI:1619965456
Name:LITTLE SISTERS OF THE POOR
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR
Other - Org Name:SACRED HEART HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-698-4331
Mailing Address - Street 1:930 S WYNN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3530
Mailing Address - Country:US
Mailing Address - Phone:419-698-4331
Mailing Address - Fax:419-698-1109
Practice Address - Street 1:930 S WYNN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3530
Practice Address - Country:US
Practice Address - Phone:419-698-4331
Practice Address - Fax:419-698-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2392N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430275Medicaid
OH2430275Medicaid