Provider Demographics
NPI:1932283157
Name:VAN RUE INC.
Entity Type:Organization
Organization Name:VAN RUE INC.
Other - Org Name:VANCREST HEALTH CARE CENTER
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:419-238-0715
Mailing Address - Street 1:10357 VAN WERT DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-9209
Mailing Address - Country:US
Mailing Address - Phone:419-238-4646
Mailing Address - Fax:419-238-5727
Practice Address - Street 1:10357 VAN WERT DECATUR RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-9209
Practice Address - Country:US
Practice Address - Phone:419-238-4646
Practice Address - Fax:419-238-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4994314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000157584OtherANTHEM
OH0147488Medicaid
OH000000157584OtherANTHEM