Provider Type Icon

COMPLETE CARE DIVERSIFIED LLC NPI 1821425042


NPI Information

NPI: 1821425042
Provider Name: COMPLETE CARE DIVERSIFIED, LLC
Classification: Residential Treatment Facility, Physical Disabilities - 320700000X
Entity Type: Organization
Address:
27511 HOLIDAY LANE
SUITE 105
PERRYSBURG, OH
ZIP 43551
Phone: (419) 873-3488
Get Directions

COMPLETE CARE DIVERSIFIED, LLC is a residential treatment facility physical disabilities in Perrysburg, OH. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently. COMPLETE CARE DIVERSIFIED, LLC NPI is 1821425042. The provider is registered as an organization entity type.

The provider's business location address is:

27511 HOLIDAY LANE
SUITE 105
PERRYSBURG, OH
ZIP 43551-315
Phone: (419) 873-3488
Fax: (419) 873-4777

The provider's authorized official is Andrew M Miller .
The authorized official title is Owner / Pt and has the following contact phone number (419) 873-3488.

The enumeration date for this NPI number is 10/2/2013 and was last updated on 10/2/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1320700000XResidential Treatment Facility, Physical DisabilitiesPT012961OHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10076646MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.