Basic Information
| Provider Information | |||||||||
| NPI: | 1306907324 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIENNA ENTERPRISES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SHARONVIEW NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| OtherNamePrefix: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 125 EAST NATIONAL ROAD | ||||||||
| Address2: | |||||||||
| City: | S. VIENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453690447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375684342 | ||||||||
| FaxNumber: | 9375684265 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 EAST NATIONAL ROAD | ||||||||
| Address2: | |||||||||
| City: | SOUTH VIENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453690447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375684342 | ||||||||
| FaxNumber: | 9375684265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WARNER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9375684342 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | NHA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 613 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7986952 | 05 | OH | MEDICAID | 613 | 01 | OH | NURSING HOME LICENSE | OTHER |