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General NPI Number Information
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NPI Number | 1528208683
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Entity Type | Organization
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Legal Business Name | OHCP
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 26241 LAKE SHORE BLVD APT 2257
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City | EUCLID
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State | OH
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Zip | 44132-1149
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Country | US
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Telephone | 216-732-7533
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Fax |
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Provider Business Mailing Address
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Address Line | 26241 LAKE SHORE BLVD APT 2257
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City | EUCLID
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State | OH
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Zip | 44132-1149
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Country | US
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Telephone | 216-732-7533
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | VANAPHOUT SANAPHOL
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Credential |
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Telephone | 216-732-7533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | PN 125076 IV
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License Number State | OH
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