Provider Demographics
NPI:1831216688
Name:WHITEHOUSE COUNTRY MANOR
Entity type:Organization
Organization Name:WHITEHOUSE COUNTRY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-877-5338
Mailing Address - Street 1:11239 WATERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9813
Mailing Address - Country:US
Mailing Address - Phone:419-877-5338
Mailing Address - Fax:419-877-1049
Practice Address - Street 1:11239 WATERVILLE ST
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9813
Practice Address - Country:US
Practice Address - Phone:419-877-5338
Practice Address - Fax:419-877-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1698N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365756Medicare ID - Type UnspecifiedMEDICARE