Healthcare Provider Details

I. General information

NPI: 1558725523
Provider Name (Legal Business Name): TOLEDO HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4428 SECOR RD STE S1
TOLEDO OH
43623-4264
US

IV. Provider business mailing address

4428 SECOR RD STE S1
TOLEDO OH
43623-4264
US

V. Phone/Fax

Practice location:
  • Phone: 419-214-0200
  • Fax:
Mailing address:
  • Phone: 419-214-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number201606801882
License Number StateOH

VIII. Authorized Official

Name: FATUMA BARQADLE
Title or Position: CEO
Credential:
Phone: 419-214-0200