Basic Information
| Provider Information | |||||||||
| NPI: | 1316954423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOLEDO REHABILITATION GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28 | ||||||||
| Address2: | |||||||||
| City: | LAMBERTVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481440028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194795960 | ||||||||
| FaxNumber: | 4194795435 | ||||||||
| Practice Location | |||||||||
| Address1: | 4235 SECOR RD | ||||||||
| Address2: | #B3 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194795960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 06/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | SCHLEMBACH | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4194795960 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 7417696 | 01 | OH | CIGNA | OTHER | 00000157408 | 01 | OH | ANTHEM BCBS | OTHER | 0611556 | 05 | OH | MEDICAID |