Provider Demographics
NPI:1790991230
Name:VRABLE I, INC.
Entity Type:Organization
Organization Name:VRABLE I, INC.
Other - Org Name:HERITAGE MANOR NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:614-545-2433
Mailing Address - Street 1:24 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-1117
Mailing Address - Country:US
Mailing Address - Phone:419-628-2396
Mailing Address - Fax:419-628-2881
Practice Address - Street 1:24 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-1117
Practice Address - Country:US
Practice Address - Phone:419-628-2396
Practice Address - Fax:419-628-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5132315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2711453Medicaid