Organization
VANCREST OF PAYNE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE HOLLIDAY (ASST CFO)
(419) 238-0715
Entity
Organization
Contact information
Practice address
650 N MAIN ST, PAYNE, OH 45880-9026
(419) 263-0191
(419) 263-0193
Mailing address
120 W MAIN ST STE 200, VAN WERT, OH 45891-1761
(419) 238-0715
(419) 238-4814
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0099863
—
OH
05
—
2641R
—
OH
Enumeration date
10/17/2013
Last updated
05/14/2026
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