Provider Demographics
NPI:1467662650
Name:EXTENDICARE
Entity Type:Organization
Organization Name:EXTENDICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRC
Authorized Official - Prefix:MR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:419-841-2200
Mailing Address - Street 1:7120 PORT SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1158
Mailing Address - Country:US
Mailing Address - Phone:419-841-2200
Mailing Address - Fax:
Practice Address - Street 1:7120 PORT SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1158
Practice Address - Country:US
Practice Address - Phone:419-841-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA3005313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility