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General NPI Number Information
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NPI Number | 1508522202
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Entity Type | Organization
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Legal Business Name | PERRYSBURG HEALTHCARE AND REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 28546 STARBRIGHT BLVD
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City | PERRYSBURG
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State | OH
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Zip | 43551-4686
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Country | US
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Telephone | 419-666-0935
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Fax |
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Provider Business Mailing Address
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Address Line | 555 ANTHONY WAYNE TRL
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City | WATERVILLE
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State | OH
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Zip | 43566-1516
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Country | US
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Telephone | 330-720-0406
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JASON DIPASQUA
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Credential |
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Telephone | 330-720-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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