Healthcare Provider Details

I. General information

NPI: 1053965541
Provider Name (Legal Business Name): ASSISTED CARE BY BLACK STONE OF TOLEDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4427 TALMADGE RD STE F
TOLEDO OH
43623-3515
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 419-861-3333
  • Fax: 419-861-4444
Mailing address:
  • Phone: 337-233-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GACHASSIN III
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 337-233-1307