Provider Demographics
NPI:1659585115
Name:FORD HULL MAR NURSING HOME, INC
Entity Type:Organization
Organization Name:FORD HULL MAR NURSING HOME, INC
Other - Org Name:ROSEWOOD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LSW
Authorized Official - Phone:740-859-6496
Mailing Address - Street 1:212 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43971-1212
Mailing Address - Country:US
Mailing Address - Phone:740-859-6496
Mailing Address - Fax:740-859-7120
Practice Address - Street 1:212 4TH ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:OH
Practice Address - Zip Code:43971-1212
Practice Address - Country:US
Practice Address - Phone:740-859-6496
Practice Address - Fax:740-859-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5332314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223010Medicaid
OH0223010Medicaid