Provider Demographics
NPI:1205207511
Name:N/A
Entity Type:Organization
Organization Name:N/A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGES SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-444-5494
Mailing Address - Street 1:3051 ELYRIA AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-1449
Mailing Address - Country:US
Mailing Address - Phone:440-444-5494
Mailing Address - Fax:
Practice Address - Street 1:3051 ELYRIA AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1449
Practice Address - Country:US
Practice Address - Phone:440-444-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OHPN097617251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health