Provider Demographics
NPI:1932276615
Name:WELLINGTON MANOR NURSING HOME INC
Entity type:Organization
Organization Name:WELLINGTON MANOR NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA RN
Authorized Official - Phone:440-647-2259
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-0393
Mailing Address - Country:US
Mailing Address - Phone:440-647-2259
Mailing Address - Fax:440-647-4332
Practice Address - Street 1:116 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-1228
Practice Address - Country:US
Practice Address - Phone:440-647-3910
Practice Address - Fax:440-647-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36E851313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9318858Medicaid