Provider Demographics
NPI:1982635066
Name:THE MARIA-JOSEPH CENTER
Entity Type:Organization
Organization Name:THE MARIA-JOSEPH CENTER
Other - Org Name:THE MARIA-JOSEPH LIVING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-278-2692
Mailing Address - Street 1:4830 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1798
Mailing Address - Country:US
Mailing Address - Phone:937-278-2692
Mailing Address - Fax:937-278-9016
Practice Address - Street 1:4830 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1798
Practice Address - Country:US
Practice Address - Phone:937-278-2692
Practice Address - Fax:937-278-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3574314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5511075Medicaid
OH5511075Medicaid
36-5322Medicare ID - Type Unspecified