Provider Demographics
NPI:1811084064
Name:ROSARY CARE CENTER
Entity type:Organization
Organization Name:ROSARY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGACRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-3673
Mailing Address - Street 1:6832 CONVENT BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4805
Mailing Address - Country:US
Mailing Address - Phone:419-824-3600
Mailing Address - Fax:419-824-3931
Practice Address - Street 1:6832 CONVENT BLVD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4805
Practice Address - Country:US
Practice Address - Phone:419-824-3600
Practice Address - Fax:419-824-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6045314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2276193Medicaid
OH2276193Medicaid