Organization
MOUNT VERNON ELDERLY SERVICES LLC
Active
Other names
Country Club Retirement Center II
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY HEAD LNHA (ADMINISTRATOR)
(740) 397-2350
Entity
Organization
Contact information
Practice address
1350 YAUGER RD, MOUNT VERNON, OH 43050-9233
(740) 397-2350
(740) 393-0546
Mailing address
1350 YAUGER RD, MOUNT VERNON, OH 43050-9233
(740) 397-2350
(740) 393-0546
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2866
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0396218
—
OH
Enumeration date
11/28/2006
Last updated
04/12/2017
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