Provider Demographics
NPI:1518335603
Name:SUPPORTIVE CARE OF OHIO LLC
Entity Type:Organization
Organization Name:SUPPORTIVE CARE OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-826-0060
Mailing Address - Street 1:20 ROBERT PITT DR
Mailing Address - Street 2:UNIT 209
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3330
Mailing Address - Country:US
Mailing Address - Phone:845-826-0060
Mailing Address - Fax:
Practice Address - Street 1:28602 YESHIVA LN
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2729
Practice Address - Country:US
Practice Address - Phone:718-506-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty