Healthcare Provider Details

I. General information

NPI: 1477540649
Provider Name (Legal Business Name): KINGSTON CARE CENTER OF SYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 KING RD
SYLVANIA OH
43560-4438
US

IV. Provider business mailing address

PO BOX 2165
TOLEDO OH
43603-2165
US

V. Phone/Fax

Practice location:
  • Phone: 419-517-8200
  • Fax: 419-517-8201
Mailing address:
  • Phone: 419-247-2880
  • Fax: 419-247-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2418N
License Number StateOH

VIII. Authorized Official

Name: MR. LARRY NIRSCHL
Title or Position: TREASURER OF MANAGING MEMBER
Credential:
Phone: 419-247-2824