MEDICARE: PROMEDICA CONTINUING CARE SERVICES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	139856	OTHER	MI	CARECHOICES OF MI
2	10133	OTHER	MI	PARAMOUNT HEALTH CARE

General Provider Information

NPI Number	:	1902881824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMEDICA CONTINUING CARE SERVICES CORP

Provider Business Mailing Address
First Line	:	1801 RICHARDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1037
Country	:	US
Telephone Number	:	419-469-3780
Fax Number	:	419-469-3781

Provider Business Practice Location Address
First Line	:	770 RIVERSIDE AVE
Second Line	:	SUITE 104
City	:	ADRIAN
State	:	MI
Zip	:	49221-1476
Country	:	US
Telephone Number	:	517-266-2568
Fax Number	:	517-266-1036

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLADEEN A ROBERTS
Credential	:
Telephone Number	:	419-469-3780

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/10/2011

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