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General NPI Number Information
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NPI Number | 1649899048
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Entity Type | Organization
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Legal Business Name | AMYRA SUPPORT SERVICES OF OHIO , LLC
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 11811 SHAKER BLVD STE 113D
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City | CLEVELAND
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State | OH
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Zip | 44120-1927
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Country | US
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Telephone | 216-759-5467
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Fax | 216-759-5460
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Provider Business Mailing Address
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Address Line | 3513 E 113TH ST
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City | CLEVELAND
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State | OH
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Zip | 44105-1829
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Country | US
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Telephone | 216-860-5228
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MYRA E. ANCAR
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Credential | OWNER
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Telephone | 216-795-5467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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