Provider Demographics
NPI:1063403582
Name:ZANDEX HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:ZANDEX HEALTH CARE CORPORATION
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:740-454-1400
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 1:1280 FRIENDSHIP DR
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-1024
Practice Address - Country:US
Practice Address - Phone:740-872-0809
Practice Address - Fax:740-826-9101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZANDEX HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-03
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5094314000000X
OH2062N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5094OtherFACILITY LICENSE NUMBER
OH0203943Medicaid
OH366173Medicare ID - Type UnspecifiedNURSING FACILITY