Organization
VANCREST OF HICKSVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDGAR SILALAHI (CFO)
(419) 238-0715
Entity
Organization
Contact information
Practice address
601 DEFIANCE AVE, HICKSVILLE, OH 43526
(419) 238-0715
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
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
03/12/2021
Last updated
03/22/2024
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