Provider Demographics
NPI:1205145018
Name:TOLEDOTH REHAB, LLC
Entity type:Organization
Organization Name:TOLEDOTH REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:614-992-4082
Mailing Address - Street 1:12220 CLARK DR
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-9166
Mailing Address - Country:US
Mailing Address - Phone:614-992-4082
Mailing Address - Fax:614-992-4083
Practice Address - Street 1:12220 CLARK DR
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9166
Practice Address - Country:US
Practice Address - Phone:614-992-4082
Practice Address - Fax:614-992-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5120171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty