Healthcare Provider Details

I. General information

NPI: 1881861060
Provider Name (Legal Business Name): HCR MANOR CARE MEDICAL SERVICES OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 EXECUTIVE PKWY SUITE 131
TOLEDO OH
43606-1326
US

IV. Provider business mailing address

3425 EXECUTIVE PKWY SUITE 131
TOLEDO OH
43606-1326
US

V. Phone/Fax

Practice location:
  • Phone: 419-531-2127
  • Fax: 419-531-2664
Mailing address:
  • Phone: 419-531-2127
  • Fax: 419-531-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BARRY A LAZARUS
Title or Position: VICE PRESIDENT
Credential:
Phone: 419-252-5518