Provider Demographics
NPI:1689662348
Name:BMNH, INC.
Entity Type:Organization
Organization Name:BMNH, INC.
Other - Org Name:BELLE MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:RUSTIN
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:937-845-3561
Mailing Address - Street 1:107 N PIKE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1817
Mailing Address - Country:US
Mailing Address - Phone:937-845-3561
Mailing Address - Fax:937-845-3339
Practice Address - Street 1:107 N PIKE ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1817
Practice Address - Country:US
Practice Address - Phone:937-845-3561
Practice Address - Fax:937-845-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH28113140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371299Medicaid
365519Medicare ID - Type Unspecified