Basic Information
| Provider Information | |||||||||
| NPI: | 1891451548 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW LEXINGTON HEALTHCARE AND REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 ANTHONY WAYNE TRL | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435661516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307200406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437641552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403425161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | DIPASQUA | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3307200406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1745N | 01 | OH | LICENSURE | OTHER |