Provider Demographics
NPI:1124088794
Name:CRANDALL MEDICAL CENTER
Entity type:Organization
Organization Name:CRANDALL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-938-6126
Mailing Address - Street 1:800 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672-2050
Mailing Address - Country:US
Mailing Address - Phone:330-938-6126
Mailing Address - Fax:330-938-7406
Practice Address - Street 1:800 S 15TH ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:OH
Practice Address - Zip Code:44672-2050
Practice Address - Country:US
Practice Address - Phone:330-938-6126
Practice Address - Fax:330-938-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479218Medicaid
OH36-5574Medicare ID - Type Unspecified