Provider Demographics
NPI:1518796564
Name:CONARD HOUSE ASSISTED LIVING
Entity type:Organization
Organization Name:CONARD HOUSE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LNHA/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:419-860-3208
Mailing Address - Street 1:71 BLYMYER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2344
Mailing Address - Country:US
Mailing Address - Phone:419-774-5160
Mailing Address - Fax:419-774-9481
Practice Address - Street 1:71 BLYMYER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2344
Practice Address - Country:US
Practice Address - Phone:419-774-5160
Practice Address - Fax:419-774-9481
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANSFIELD MEMORIAL HOMES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility