Healthcare Provider Details

I. General information

NPI: 1235112657
Provider Name (Legal Business Name): TOLEDO RETIREMENT & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 OBRIE ST
ZWOLLE LA
71486-2510
US

IV. Provider business mailing address

PO BOX 1009
ZWOLLE LA
71486-1009
US

V. Phone/Fax

Practice location:
  • Phone: 318-645-2800
  • Fax: 318-645-2645
Mailing address:
  • Phone: 318-645-2800
  • Fax: 318-645-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number471
License Number StateLA

VIII. Authorized Official

Name: MR. JACK SANDERS
Title or Position: MANAGING MEMBERS
Credential:
Phone: 318-590-0007