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General NPI Number Information
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NPI Number | 1104122340
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Entity Type | Organization
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Legal Business Name | BUREAU OF LONG-TERM CARE SERVICES AND SUPPORTS
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 818 KICKAPOO AVE
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City | AKRON
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State | OH
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Zip | 44305-1208
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Country | US
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Telephone | 330-780-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 818 KICKAPOO AVE
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City | AKRON
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State | OH
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Zip | 44305-1208
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Country | US
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Telephone | 330-780-1270
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MRS. SARAH BREANNA HANSON
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Credential |
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Telephone | 330-780-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | PN 109895
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License Number State | OH
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