Provider Demographics
NPI:1497822092
Name:PROMEDICA CONTINUING CARE SERVICES CORP
Entity Type:Organization
Organization Name:PROMEDICA CONTINUING CARE SERVICES CORP
Other - Org Name:PROMEDICA HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLADEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-469-3780
Mailing Address - Street 1:1801 RICHARDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1037
Mailing Address - Country:US
Mailing Address - Phone:419-469-3780
Mailing Address - Fax:419-469-3781
Practice Address - Street 1:2751 BAY PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4921
Practice Address - Country:US
Practice Address - Phone:419-690-7572
Practice Address - Fax:419-697-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4405016Medicaid
OH2828622Medicaid
OH10133OtherPARAMOUNT
OH2828622Medicaid