Provider Demographics
NPI:1013173129
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:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-469-3780
Mailing Address - Street 1:4345 SECOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4233
Mailing Address - Country:US
Mailing Address - Phone:419-291-8240
Mailing Address - Fax:419-480-1268
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-6840
Practice Address - Fax:419-480-8711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMEDICA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-29
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH179937OtherVENDOR LICENSE
OH179937OtherVENDOR LICENSE