Provider Demographics
NPI:1245073212
Name:ST. CLARE COMMONS
Entity type:Organization
Organization Name:ST. CLARE COMMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ANCILLARY CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-562-7202
Mailing Address - Street 1:12469 FIVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9615
Mailing Address - Country:US
Mailing Address - Phone:419-931-0050
Mailing Address - Fax:419-931-0052
Practice Address - Street 1:12469 FIVE POINT RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-9615
Practice Address - Country:US
Practice Address - Phone:419-931-0050
Practice Address - Fax:419-931-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility