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General NPI Number Information
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NPI Number | 1447588124
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Entity Type | Organization
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Legal Business Name | VICTORIAN MANOR 2, INC.
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 2205 PARKWOOD AVE
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City | TOLEDO
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State | OH
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Zip | 43620-1125
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Country | US
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Telephone | 419-242-9707
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Fax | 419-243-1688
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Provider Business Mailing Address
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Address Line | 2205 PARKWOOD AVE
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City | TOLEDO
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State | OH
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Zip | 43620-1125
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Country | US
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Telephone | 419-242-9707
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Fax | 419-243-1688
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLIFF P GASTON
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Credential |
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Telephone | 614-732-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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