Provider Demographics
NPI:1427001577
Name:TRADITIONS CARE AND REHABILITATION, INC.
Entity Type:Organization
Organization Name:TRADITIONS CARE AND REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:419-536-7600
Mailing Address - Street 1:1011 N BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2710
Mailing Address - Country:US
Mailing Address - Phone:419-536-7600
Mailing Address - Fax:419-536-7601
Practice Address - Street 1:1011 N BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-2710
Practice Address - Country:US
Practice Address - Phone:419-536-7600
Practice Address - Fax:419-536-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0343N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2678900Medicaid
OH2678900Medicaid