Healthcare Provider Details

I. General information

NPI: 1295542892
Provider Name (Legal Business Name): PERRYSBURG OH HEALTH & REHAB OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28546 STARBRIGHT BLVD
PERRYSBURG OH
43551-4686
US

IV. Provider business mailing address

28546 STARBRIGHT BLVD
PERRYSBURG OH
43551-4686
US

V. Phone/Fax

Practice location:
  • Phone: 419-666-0935
  • Fax:
Mailing address:
  • Phone: 419-666-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL PRUITT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 317-288-4029