Provider Demographics
NPI:1073842712
Name:PALLADIUM HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:PALLADIUM HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAWANNA
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-280-0584
Mailing Address - Street 1:325 W 48TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6969
Mailing Address - Country:US
Mailing Address - Phone:440-992-2312
Mailing Address - Fax:440-992-0156
Practice Address - Street 1:325 W 48TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6969
Practice Address - Country:US
Practice Address - Phone:440-992-2312
Practice Address - Fax:440-992-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH337958251E00000X, 251F00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care