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NPI Code Detail

MEDICARE: KINGSTON OF VERMILION, LLC

MEDICARE: KINGSTON OF VERMILION, LLC
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
1314000000XSkilled Nursing Facility1806NOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000228658OTHEROHANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356338594
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINGSTON OF VERMILION, LLC
Provider Business Mailing Address
First Line : PO BOX 2165
Second Line :
City : TOLEDO
State : OH
Zip : 43603-2165
Country : US
Telephone Number : 419-247-2880
Fax Number : 419-247-2872
Provider Business Practice Location Address
First Line : 4210 TELEGRAPH LN
Second Line :
City : VERMILION
State : OH
Zip : 44089-3748
Country : US
Telephone Number : 440-967-1800
Fax Number : 440-967-0122
Authorized Official
Title or Position : TREASURER
Name : MR. LARRY NIRSCHL
Credential :
Telephone Number : 419-247-2824
Provider Enumeration Date : 10/03/2005
Last Update Date : 08/22/2020

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