Organization
PROMEDICA CONTINUING CARE SERVICES CORP
Active
Other names
Lake Park
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLADEEN ROBERTS PHD (PRESIDENT)
(419) 824-5660
Entity
Organization
Contact information
Practice address
5100 HARROUN RD, SYLVANIA, OH 43560-2110
(419) 824-1000
Mailing address
5100 HARROUN RD, SYLVANIA, OH 43560-2110
(419) 824-1000
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0036786
—
OH
Enumeration date
03/24/2006
Last updated
08/22/2020
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