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General NPI Number Information
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NPI Number | 1639018989
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Entity Type | Organization
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Legal Business Name | GARDEN LAKE SNF OPERATIONS LLC
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 955 GARDEN LAKE PKWY
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City | TOLEDO
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State | OH
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Zip | 43614-2777
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Country | US
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Telephone | 419-382-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 955 GARDEN LAKE PKWY
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City | TOLEDO
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State | OH
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Zip | 43614-2777
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Country | US
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Telephone | 419-382-2200
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MATIS MARK FRIEDMAN
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Credential |
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Telephone | 216-282-9402
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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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