1982642500 NPI number — MANOR CARE-PIKE CREEK OF WILMINGTON DE LLC

Table of content: (NPI 1982642500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982642500 NPI number — MANOR CARE-PIKE CREEK OF WILMINGTON DE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANOR CARE-PIKE CREEK OF WILMINGTON DE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROMEDICA SKILLED NURSING AND REHABILITATION (PIKE CREEK)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982642500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 N SUMMIT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-252-5500
Provider Business Mailing Address Fax Number:
877-385-9446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5651 LIMESTONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-239-8583
Provider Business Practice Location Address Fax Number:
302-239-4523
Provider Enumeration Date:
06/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
419-252-5743

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1516 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000067811 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".