Healthcare Provider Details

I. General information

NPI: 1528208683
Provider Name (Legal Business Name): OHCP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26241 LAKE SHORE BLVD APT 2257
EUCLID OH
44132-1149
US

IV. Provider business mailing address

26241 LAKE SHORE BLVD APT 2257
EUCLID OH
44132-1149
US

V. Phone/Fax

Practice location:
  • Phone: 216-732-7533
  • Fax:
Mailing address:
  • Phone: 216-732-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberPN 125076 IV
License Number StateOH

VIII. Authorized Official

Name: VANAPHOUT SANAPHOL
Title or Position: LPN
Credential:
Phone: 216-732-7533