Promedica Continuing Care Services Corp

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PROMEDICA CONTINUING CARE SERVICES CORP

Doing business as

Lake Park

Practice address

5100 Harroun Rd
Sylvania, OH 43560-2110

Phone

(419) 824-1000

NPI assigned

Mar 24, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gladeen Roberts, PHD

Title

President

Phone

(419) 824-5660

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Park Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265492334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 HARROUN RD",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602110",
            "telephone_number": "419-824-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 HARROUN RD",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602110",
            "telephone_number": "419-824-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CONTINUING CARE SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "GLADEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-824-5660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0036786",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Promedica Central Physicians, LLC (ProMedica Hearing Center)
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• Promedica Central Physicians, LLC (Northwest Ohio ENT Consultants)
• Promedica Central Physicians,LLC (Harroun Road Family Physicians)
• Promedica Continuing Care Services Corp (Goerlich Center)
• Promedica Genito-Urinary Surgeons LLC (Carin V Hopps MD)
• Promedica Health System
• Promedica of Sylvania Oh, LLC (ProMedica Goerlich Memory Center (Sylvania))
• Katherine Prots
• Rebecca Przybylski

• Skilled Nursing Facility in Sylvania, OH
• Providers in Sylvania, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.