Individual ProviderMarie DouglassCase Manager/Care CoordinatorOther Service ProvidersPractice Address6715 Dorr St., Toledo, OH 43615(419) 868-1178PECOS EnrollmentBased on the most recent information from CMS, provider Marie Douglass does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1487153581Provider TypeIndividualFull NameDouglass, MarieTitleMrs.GenderFemaleSole ProprietorNoEnumeration Date2/5/2018Last Updated2/5/2018Contact InformationPractice LocationPractice Address6715 Dorr St., Toledo, OH 43615Phone(419) 868-1178Fax(419) 868-1989Mailing LocationMailing AddressPO Box 400, Holland, OH 43528Phone(419) 868-1178Fax(419) 868-1989Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID2846586DescriptionMedicaidIssuerUnlistedOhio