Healthcare Provider Details

I. General information

NPI: 1114837507
Provider Name (Legal Business Name): ANDRENAI THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 KINGSWOOD TRAIL DR
TOLEDO OH
43615-5417
US

IV. Provider business mailing address

308 KINGSWOOD TRAIL DR
TOLEDO OH
43615-5417
US

V. Phone/Fax

Practice location:
  • Phone: 419-724-1500
  • Fax: 419-724-1616
Mailing address:
  • Phone: 419-724-1500
  • Fax: 419-724-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: