Provider Demographics
NPI:1265423727
Name:ZANDEX HEALTH CARE CORP
Entity type:Organization
Organization Name:ZANDEX HEALTH CARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:740-588-2154
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:1122 TAYLOR STREET
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-0730
Mailing Address - Country:US
Mailing Address - Phone:740-454-1400
Mailing Address - Fax:740-454-7439
Practice Address - Street 1:267 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031
Practice Address - Country:US
Practice Address - Phone:740-967-7896
Practice Address - Fax:740-927-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0355N314000000X
OH4630313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0035492Medicaid
366212Medicare ID - Type Unspecified