MEDICARE: OHCP

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	251J00000X	Nursing Care Agency	PN 125076 IV	OH

General Provider Information

NPI Number	:	1528208683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHCP

Provider Business Mailing Address
First Line	:	26241 LAKE SHORE BLVD APT 2257
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1149
Country	:	US
Telephone Number	:	216-732-7533
Fax Number	:

Provider Business Practice Location Address
First Line	:	26241 LAKE SHORE BLVD APT 2257
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1149
Country	:	US
Telephone Number	:	216-732-7533
Fax Number	:

Authorized Official
Title or Position	:	LPN
Name	:	VANAPHOUT SANAPHOL
Credential	:
Telephone Number	:	216-732-7533

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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Directions to “OHCP ” Practice Location

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