Provider Demographics
NPI:1649782921
Name:SPRENGER HEALTHCARE OF PORT ROYAL, INC
Entity type:Organization
Organization Name:SPRENGER HEALTHCARE OF PORT ROYAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIEDENMANNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-989-5238
Mailing Address - Street 1:3905 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2853
Mailing Address - Country:US
Mailing Address - Phone:440-989-5238
Mailing Address - Fax:440-989-4362
Practice Address - Street 1:1810 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2015
Practice Address - Country:US
Practice Address - Phone:440-989-5238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility