MEDICARE: RITAS ELECTROLYSIS CLINIC & PERSONAL CARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	32.003835-N-R	OH

General Provider Information

NPI Number	:	1407228851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITAS ELECTROLYSIS CLINIC & PERSONAL CARE CENTER LLC

Provider Business Mailing Address
First Line	:	27540 DETROIT RD
Second Line	:	STE 105
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2299
Country	:	US
Telephone Number	:	440-835-1047
Fax Number	:

Provider Business Practice Location Address
First Line	:	27540 DETROIT RD
Second Line	:	STE 105
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2299
Country	:	US
Telephone Number	:	440-835-1047
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ELECTROLOGIST
Name	:	MS. RITA MARIE OLIMAN
Credential	:	C.T.
Telephone Number	:	440-835-1047

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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