Healthcare Provider Details

I. General information

NPI: 1215143417
Provider Name (Legal Business Name): INTEGRATED HEALTH SERVICES OF NEW LONDON AT FIRELANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MAIN ST
NEW LONDON OH
44851-1070
US

IV. Provider business mailing address

1680 MICHIGAN AVE SUITE 736
MIAMI BEACH FL
33139-2538
US

V. Phone/Fax

Practice location:
  • Phone: 305-892-1790
  • Fax: 305-538-2699
Mailing address:
  • Phone: 305-892-1790
  • Fax: 305-538-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1825N
License Number StateOH

VIII. Authorized Official

Name: MR. THEODORE M. DUAY III
Title or Position: CFO
Credential: CPA
Phone: 305-892-1790