Healthcare Provider Details

I. General information

NPI: 1588719769
Provider Name (Legal Business Name): COMMUNITY RESIDENTIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N. MICHIGAN ST. SUITE 217
TOLEDO OH
43604-6941
US

IV. Provider business mailing address

151 N. MICHIGAN ST. SUITE 217
TOLEDO OH
43604-6941
US

V. Phone/Fax

Practice location:
  • Phone: 419-255-5200
  • Fax: 419-255-0761
Mailing address:
  • Phone: 419-255-5200
  • Fax: 419-255-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0886046
License Number StateOH

VIII. Authorized Official

Name: MR. LARRY L. COVERT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 419-255-5200