Healthcare Provider Details

I. General information

NPI: 1265578348
Provider Name (Legal Business Name): SARA'S GARDEN-THE SARA JOY RYCHENER-BURKHOLDER HYPERBARIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W LEGGETT ST
WAUSEON OH
43567-1348
US

IV. Provider business mailing address

620 W LEGGETT ST PO BOX 150
WAUSEON OH
43567-1348
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-7272
  • Fax: 419-335-5564
Mailing address:
  • Phone: 419-335-7272
  • Fax: 419-335-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number02-1518550
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW JAMES RYCHENER
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 419-335-7272