Provider Demographics
NPI:1285618124
Name:HEALTHCARE VENTURES OF OHIO LLC
Entity type:Organization
Organization Name:HEALTHCARE VENTURES OF OHIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:419-399-4940
Mailing Address - Street 1:1017 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1544
Mailing Address - Country:US
Mailing Address - Phone:419-399-4940
Mailing Address - Fax:419-399-4699
Practice Address - Street 1:1017 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1544
Practice Address - Country:US
Practice Address - Phone:419-399-4940
Practice Address - Fax:419-399-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1527N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2561517Medicaid
OH2561517Medicaid