Healthcare Provider Details

I. General information

NPI: 1235596933
Provider Name (Legal Business Name): DENISE M HLAVACIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38295 KINGSTON DR
NORTH RIDGEVILLE OH
44039-1098
US

IV. Provider business mailing address

38295 KINGSTON DR
NORTH RIDGEVILLE OH
44039-1098
US

V. Phone/Fax

Practice location:
  • Phone: 440-668-1517
  • Fax: 440-309-4823
Mailing address:
  • Phone: 440-668-1517
  • Fax: 440-309-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: