MEDICARE: THE SHEPHERDS HOUSE

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	251V00000X	Voluntary or Charitable Agency	05-4744	OH

General Provider Information

NPI Number	:	1073661260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SHEPHERDS HOUSE

Provider Business Mailing Address
First Line	:	1231 ALBERT ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43605-3610
Country	:	US
Telephone Number	:	419-691-8479
Fax Number	:	419-698-4203

Provider Business Practice Location Address
First Line	:	1231 ALBERT ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43605-3610
Country	:	US
Telephone Number	:	419-691-8479
Fax Number	:	419-698-4203

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. PEGGY LYNN WAGNER
Credential	:	C.P.R
Telephone Number	:	419-691-8479

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	08/22/2020

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Directions to “THE SHEPHERDS HOUSE ” Practice Location

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