Provider Demographics
NPI:1639357007
Name:DESERET NURSING AND REHABILITATION AT MANSFIELD
Entity Type:Organization
Organization Name:DESERET NURSING AND REHABILITATION AT MANSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5105
Mailing Address - Street 1:2124 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3807
Mailing Address - Country:US
Mailing Address - Phone:419-529-6447
Mailing Address - Fax:419-529-2108
Practice Address - Street 1:2124 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3807
Practice Address - Country:US
Practice Address - Phone:419-529-6447
Practice Address - Fax:419-529-2108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERET NURSING AND REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility