Healthcare Provider Details

I. General information

NPI: 1962317099
Provider Name (Legal Business Name): PERRYSBURG ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10542 FREMONT PIKE
PERRYSBURG OH
43551-3385
US

IV. Provider business mailing address

10542 FREMONT PIKE
PERRYSBURG OH
43551-3385
US

V. Phone/Fax

Practice location:
  • Phone: 419-874-1931
  • Fax:
Mailing address:
  • Phone: 419-874-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL PRUITT
Title or Position: CEO
Credential:
Phone: 317-288-4029