Healthcare Provider Details

I. General information

NPI: 1508522202
Provider Name (Legal Business Name): PERRYSBURG HEALTHCARE AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28546 STARBRIGHT BLVD
PERRYSBURG OH
43551-4686
US

IV. Provider business mailing address

555 ANTHONY WAYNE TRL
WATERVILLE OH
43566-1516
US

V. Phone/Fax

Practice location:
  • Phone: 419-666-0935
  • Fax:
Mailing address:
  • Phone: 330-720-0406
  • 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: JASON DIPASQUA
Title or Position: COO
Credential:
Phone: 330-720-0406