Healthcare Provider Details

I. General information

NPI: 1639018989
Provider Name (Legal Business Name): GARDEN LAKE SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 GARDEN LAKE PKWY
TOLEDO OH
43614-2777
US

IV. Provider business mailing address

955 GARDEN LAKE PKWY
TOLEDO OH
43614-2777
US

V. Phone/Fax

Practice location:
  • Phone: 419-382-2200
  • Fax:
Mailing address:
  • Phone: 419-382-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MATIS MARK FRIEDMAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 216-282-9402