Provider Demographics
NPI:1235112657
Name:TOLEDO RETIREMENT & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:TOLEDO RETIREMENT & REHABILITATION CENTER, LLC
Other - Org Name:TOLEDO NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBERS
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-590-0007
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:ZWOLLE
Mailing Address - State:LA
Mailing Address - Zip Code:71486-1009
Mailing Address - Country:US
Mailing Address - Phone:318-645-2800
Mailing Address - Fax:318-645-2645
Practice Address - Street 1:1009 OBRIE ST
Practice Address - Street 2:
Practice Address - City:ZWOLLE
Practice Address - State:LA
Practice Address - Zip Code:71486-2510
Practice Address - Country:US
Practice Address - Phone:318-645-2800
Practice Address - Fax:318-645-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA471314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1518042Medicaid
LA1518042Medicaid