Healthcare Provider Details

I. General information

NPI: 1639514268
Provider Name (Legal Business Name): HRADCO ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 PEARL RD
BRUNSWICK OH
44212-3256
US

IV. Provider business mailing address

89 WELLSLEY PL
BRUNSWICK OH
44212-1346
US

V. Phone/Fax

Practice location:
  • Phone: 330-273-4148
  • Fax:
Mailing address:
  • Phone: 330-273-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINA HRADEK
Title or Position: PRESIDENT
Credential:
Phone: 330-273-4148