Provider Demographics
NPI:1235310343
Name:RESTORATIVE SUPPORT SYSTEMS CO
Entity Type:Organization
Organization Name:RESTORATIVE SUPPORT SYSTEMS CO
Other - Org Name:RSSC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:MARKULIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:330-286-3414
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0625
Mailing Address - Country:US
Mailing Address - Phone:330-286-3414
Mailing Address - Fax:330-286-5084
Practice Address - Street 1:565 E MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1598
Practice Address - Country:US
Practice Address - Phone:330-286-3414
Practice Address - Fax:330-286-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006109332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2402797Medicaid
OH2402797Medicaid