Provider Demographics
NPI:1588088736
Name:VANCREST OF NEW CARLISLE LLC
Entity type:Organization
Organization Name:VANCREST OF NEW CARLISLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:MCCLEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-0715
Mailing Address - Street 1:107 N PIKE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1817
Mailing Address - Country:US
Mailing Address - Phone:937-845-3561
Mailing Address - Fax:
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1761
Practice Address - Country:US
Practice Address - Phone:419-238-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility