Provider Demographics
NPI:1306907324
Name:VIENNA ENTERPRISES INC
Entity type:Organization
Organization Name:VIENNA ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:937-568-4342
Mailing Address - Street 1:125 EAST NATIONAL ROAD
Mailing Address - Street 2:
Mailing Address - City:S. VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45369-0447
Mailing Address - Country:US
Mailing Address - Phone:937-568-4342
Mailing Address - Fax:937-568-4265
Practice Address - Street 1:125 EAST NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH VIENNA
Practice Address - State:OH
Practice Address - Zip Code:45369-0447
Practice Address - Country:US
Practice Address - Phone:937-568-4342
Practice Address - Fax:937-568-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH613314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7986952Medicaid
OH613OtherNURSING HOME LICENSE