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General NPI Number Information
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NPI Number | 1497822092
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Entity Type | Organization
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Legal Business Name | PROMEDICA CONTINUING CARE SERVICES CORP
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 2751 BAY PARK DR SUITE 110
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City | OREGON
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State | OH
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Zip | 43616-4921
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Country | US
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Telephone | 419-690-7572
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Fax | 419-697-2418
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Provider Business Mailing Address
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Address Line | 1801 RICHARDS RD
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City | TOLEDO
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State | OH
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Zip | 43607-1037
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Country | US
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Telephone | 419-469-3780
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Fax | 419-469-3781
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLADEEN A ROBERTS
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Credential |
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Telephone | 419-469-3780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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