Healthcare Provider Details

I. General information

NPI: 1578336186
Provider Name (Legal Business Name): SUSAN ELAINE HRENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 SLATE HOLLOW DR
POWELL OH
43065-9796
US

IV. Provider business mailing address

5702 WHISPERING RIDGE DR
GALENA OH
43021-8050
US

V. Phone/Fax

Practice location:
  • Phone: 740-369-2919
  • Fax:
Mailing address:
  • Phone: 740-360-5216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: