Provider Demographics
NPI:1992040497
Name:VANCREST OF NEW CARLISLE
Entity Type:Organization
Organization Name:VANCREST OF NEW CARLISLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCLEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-0715
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1761
Mailing Address - Country:US
Mailing Address - Phone:419-238-0715
Mailing Address - Fax:419-238-4814
Practice Address - Street 1:1885 N DAYTON LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-8292
Practice Address - Country:US
Practice Address - Phone:937-845-8219
Practice Address - Fax:937-845-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2553R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility