Healthcare Provider Details

I. General information

NPI: 1477170439
Provider Name (Legal Business Name): ASSURANCE HEALTH TOLEDO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 KING RD
SYLVANIA OH
43560-4442
US

IV. Provider business mailing address

8465 KEYSTONE XING STE 210
INDIANAPOLIS IN
46240-4354
US

V. Phone/Fax

Practice location:
  • Phone: 317-870-1396
  • Fax:
Mailing address:
  • Phone: 317-870-1396
  • Fax: 317-757-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MORRIS LONG
Title or Position: OWNER
Credential:
Phone: 317-870-1396