MEDICARE: ASSISTANCE HEALTH CARE AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1013694744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTANCE HEALTH CARE AGENCY

Provider Business Mailing Address
First Line	:	3128 TREMAINSVILLE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-1804
Country	:	US
Telephone Number	:	419-279-6612
Fax Number	:

Provider Business Practice Location Address
First Line	:	3128 TREMAINSVILLE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-1804
Country	:	US
Telephone Number	:	419-279-6612
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS ADEOLA LATIFAT YUSUF
Credential	:	MD
Telephone Number	:	419-279-6612

Provider Enumeration Date	:	07/04/2023
Last Update Date	:	07/04/2023

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