Provider Demographics
NPI:1942631981
Name:ERIKSTEN, LLC.
Entity Type:Organization
Organization Name:ERIKSTEN, LLC.
Other - Org Name:CARLIN HOUSE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:740-380-6383
Mailing Address - Street 1:12 CARLIN DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9273
Mailing Address - Country:US
Mailing Address - Phone:740-380-6383
Mailing Address - Fax:740-380-1024
Practice Address - Street 1:12 CARLIN DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9273
Practice Address - Country:US
Practice Address - Phone:740-380-6383
Practice Address - Fax:740-380-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2415R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility