NPIMap

Organization Active NPI

Eileen Community Residence

  • Intellectual Disabilities Intermediate Care Facility
  • Toledo, OH
National Provider Identifier
1548415839
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
EILEEN COMMUNITY RESIDENCE
Practice address
4816 Dorr St
Toledo, OH 43615
Phone
(419) 866-6500
Fax
(419) 866-7457
NPI assigned
Dec 1, 2008
Last updated
Apr 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Authorized official

Name
Steven King
Title
Executive Director
Phone
(419) 866-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

4816 Dorr St
Toledo, OH 43615

Mailing address

1525 Eber Rd
Holland, OH 43528-9616
Phone (419) 866-6500

Other identifiers 1

IdentifierTypeStateIssuer
2681058MedicaidOH

Other names 1

  • Eileen Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548415839. Details of each certification follow.

  • CCN 36G620 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G620

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
EILEEN COMMUNITY RESIDENCE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 25, 2006
Last certification
Oct 21, 2025
Beds
8
Ownership / control type
Private (non-profit)
Facility address
4816 Dorr Street
Toledo, OH 43615

National Provider Directory

National Provider Directory
Tax ID family
Anne Grady Corporation9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4816 Dorr St
Toledo, OH 43615
Phone (419) 866-6500

NPI Registry JSON

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

{
    "created_epoch": "1228089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1548415839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 EBER RD",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435289616",
            "telephone_number": "419-866-6500",
            "fax_number": "419-866-7457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4816 DORR ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "43615",
            "telephone_number": "419-866-6500",
            "fax_number": "419-866-7457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EILEEN COMMUNITY RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-01",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "419-866-6500"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2681058",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eileen",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Eileen",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.