Basic Information
| Provider Information | |||||||||
| NPI: | 1407281140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUPPLEMENTAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1148 KRNDIA CT | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442122254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302252786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6500 ROCKSIDE RD | ||||||||
| Address2: | STE. 240 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441312368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779070400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2013 | ||||||||
| LastUpdateDate: | 09/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARMELLI | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | RESPIRATORY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3302252786 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RRT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | RCP.8943 | OH | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.