Provider Demographics
NPI:1760572564
Name:HOLGATE CARE CENTER, LLC
Entity Type:Organization
Organization Name:HOLGATE CARE CENTER, LLC
Other - Org Name:VANCREST HEALTH CARE CENTER OF HOLGATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:EYANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-264-0700
Mailing Address - Street 1:600 JOE E BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLGATE
Mailing Address - State:OH
Mailing Address - Zip Code:43527-9803
Mailing Address - Country:US
Mailing Address - Phone:419-264-0700
Mailing Address - Fax:
Practice Address - Street 1:600 JOE E BROWN AVE
Practice Address - Street 2:
Practice Address - City:HOLGATE
Practice Address - State:OH
Practice Address - Zip Code:43527-9803
Practice Address - Country:US
Practice Address - Phone:419-264-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6278314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2366112Medicaid
OH000000216324OtherANTHEM
OH000000216324OtherANTHEM