Provider Demographics
NPI:1710545900
Name:ROD COMFORTERS
Entity Type:Organization
Organization Name:ROD COMFORTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOFAH
Authorized Official - Suffix:JR
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:216-220-7557
Mailing Address - Street 1:8207 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5509
Mailing Address - Country:US
Mailing Address - Phone:216-220-7557
Mailing Address - Fax:216-920-6216
Practice Address - Street 1:8207 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5509
Practice Address - Country:US
Practice Address - Phone:216-220-7557
Practice Address - Fax:216-920-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty