Organization
FAMILY CARE SUPPORTIVE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATESHA R WILSON (CEO)
(419) 973-6124
Entity
Organization
Contact information
Practice address
5012 SAINT AUBIN DR, TOLEDO, OH 43615-5913
(567) 686-6057
Mailing address
5012 SAINT AUBIN DR, TOLEDO, OH 43615-5913
(567) 686-6057
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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