Healthcare Provider Details

I. General information

NPI: 1881937647
Provider Name (Legal Business Name): PRESTON HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 WAMBA AVE
TOLEDO OH
43607-3331
US

IV. Provider business mailing address

PO BOX 3135
TOLEDO OH
43607-0135
US

V. Phone/Fax

Practice location:
  • Phone: 419-531-1200
  • Fax: 419-531-1200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number4806571
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number0075918
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0075918
License Number StateOH

VIII. Authorized Official

Name: MISS BRANDIE PRESTON
Title or Position: CEO
Credential:
Phone: 419-531-1200