Provider Demographics
NPI:1053460485
Name:FILLING MEMORIAL HOME EGLY
Entity type:Organization
Organization Name:FILLING MEMORIAL HOME EGLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MBOL
Authorized Official - Phone:419-592-6451
Mailing Address - Street 1:N 160 SB 108
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9363
Mailing Address - Country:US
Mailing Address - Phone:419-592-6451
Mailing Address - Fax:419-599-5178
Practice Address - Street 1:101 EGLY DRIVE
Practice Address - Street 2:
Practice Address - City:WEST UNITY
Practice Address - State:OH
Practice Address - Zip Code:43570-9533
Practice Address - Country:US
Practice Address - Phone:419-924-2806
Practice Address - Fax:419-924-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH24432315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361439Medicaid
9222OtherODH
OH36GX262Medicare ID - Type Unspecified