Provider Demographics
NPI:1477540649
Name:KINGSTON CARE CENTER OF SYLVANIA, LLC
Entity Type:Organization
Organization Name:KINGSTON CARE CENTER OF SYLVANIA, LLC
Other - Org Name:KINGSTON CARE CENTER OF SYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER OF MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIRSCHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-247-2824
Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43603-2165
Mailing Address - Country:US
Mailing Address - Phone:419-247-2880
Mailing Address - Fax:419-247-2872
Practice Address - Street 1:4121 KING RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4438
Practice Address - Country:US
Practice Address - Phone:419-517-8200
Practice Address - Fax:419-517-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2418N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2526038Medicaid
OH2526038Medicaid
OH=========Medicare UPIN