Healthcare Provider Details

I. General information

NPI: 1013517408
Provider Name (Legal Business Name): RUTH MARIE HLASKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 STURBRIDGE DR UNIT 2
MEDINA OH
44256-4381
US

IV. Provider business mailing address

651 STURBRIDGE DR UNIT 2
MEDINA OH
44256-4381
US

V. Phone/Fax

Practice location:
  • Phone: 330-441-1559
  • Fax:
Mailing address:
  • Phone: 330-441-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: