Provider Demographics
NPI:1255868865
Name:PRO SUPPORTS PLUS, LLC
Entity Type:Organization
Organization Name:PRO SUPPORTS PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-565-4951
Mailing Address - Street 1:58 VILLAGE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7760
Mailing Address - Country:US
Mailing Address - Phone:614-543-1743
Mailing Address - Fax:614-543-1743
Practice Address - Street 1:58 VILLAGE POINTE DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7760
Practice Address - Country:US
Practice Address - Phone:614-543-1743
Practice Address - Fax:614-543-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1276332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies