Provider Demographics
NPI:1851670020
Name:KINGSTON RESIDENCE OF VERMILION, LLC
Entity Type:Organization
Organization Name:KINGSTON RESIDENCE OF VERMILION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
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 1:1 SEAGATE
Mailing Address - Street 2:SUITE #1960
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-247-2880
Mailing Address - Fax:419-247-2872
Practice Address - Street 1:6010 W LAKE RD
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2838
Practice Address - Country:US
Practice Address - Phone:440-967-2424
Practice Address - Fax:440-967-2669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSTON HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2239R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility