Complete Care Diversified, LLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

PT012961 Issued in OH

Legal business name

COMPLETE CARE DIVERSIFIED, LLC

Practice address

27511 Holiday Lane
Suite 105
Perrysburg, OH 43551-5315

Phone

(419) 873-3488

Fax

(419) 873-4777

NPI assigned

Oct 2, 2013

Last updated

Oct 2, 2013By 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

Mr. Andrew M Miller, PT

Title

Owner / PT

Phone

(419) 873-3488

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1821425042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27511 HOLIDAY LANE",
            "address_2": "SUITE 105",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515315",
            "telephone_number": "419-873-3488",
            "fax_number": "419-873-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27511 HOLIDAY LANE",
            "address_2": "SUITE 105",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515315",
            "telephone_number": "419-873-3488",
            "fax_number": "419-873-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CARE DIVERSIFIED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER / PT",
        "authorized_official_telephone_number": "419-873-3488",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "OH",
            "license": "PT012961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076646",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jashala Coleman, QMHS
• Annette Kay Collier, MD
• Brian James Collins
• Colt Enterprises, Inc (Right At Home)
• Colt Enterprises, Inc (Right At Home)
• Complete Care Physical Therapy, LLC
• Jean M Cook, L.P.C.C.
• Shauna Cooley
• Christopher J Cooper, M.D.
• Mark W Cooper, DO

• Physical Disabilities Residential Treatment Facility in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• Physical Disabilities Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; 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.