Healthcare Provider Details

I. General information

NPI: 1932918521
Provider Name (Legal Business Name): PEGGY SUE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEGGY SUE CHILDRESS

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 AIRPORT HWY
TOLEDO OH
43609-1825
US

IV. Provider business mailing address

2129 AIRPORT HWY
TOLEDO OH
43609-1825
US

V. Phone/Fax

Practice location:
  • Phone: 419-770-7310
  • Fax:
Mailing address:
  • Phone: 419-770-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code2278P4000X
TaxonomyPatient Transport Certified Respiratory Therapist
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: