MEDICARE: DIVERSIFIED HEALTH CARE INC.

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	208D00000X	General Practice Physician	34.002769	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548710866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	1708 MERRIMAN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-5252
Country	:	US
Telephone Number	:	330-836-4466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 MERRIMAN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-5252
Country	:	US
Telephone Number	:	330-836-4466
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EUGENE D POGORELEC
Credential	:	D.O.
Telephone Number	:	330-836-4466

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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