Basic Information
| Provider Information | |||||||||
| NPI: | 1285107151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMEDICA OF ADRIAN MI, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436042615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192525500 | ||||||||
| FaxNumber: | 8004803780 | ||||||||
| Practice Location | |||||||||
| Address1: | 581 KIMOLE LN | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172650690 | ||||||||
| FaxNumber: | 5172660704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2019 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4192525734 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.