Provider Demographics
NPI:1962492751
Name:ANCHOR LODGE NURSING HOME, INC.
Entity Type:Organization
Organization Name:ANCHOR LODGE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX MEDICARE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDENMANNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-989-5238
Mailing Address - Street 1:3756 W ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1292
Mailing Address - Country:US
Mailing Address - Phone:440-244-2019
Mailing Address - Fax:440-244-5612
Practice Address - Street 1:3756 W ERIE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1292
Practice Address - Country:US
Practice Address - Phone:440-244-2019
Practice Address - Fax:440-244-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0556N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000156341OtherANTHEM
OH000000357080OtherANTHEM PT
OH000000357082OtherANTHEM ST
OH000000357081OtherANTHEM OT
OH0072442Medicaid
OH=========004OtherMEDICAL MUTUAL
OH000000357081OtherANTHEM OT
OH0570170001Medicare NSC