Provider Demographics
NPI:1265578348
Name:SARA'S GARDEN-THE SARA JOY RYCHENER-BURKHOLDER HYPERBARIC CENTER
Entity type:Organization
Organization Name:SARA'S GARDEN-THE SARA JOY RYCHENER-BURKHOLDER HYPERBARIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RYCHENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-335-7272
Mailing Address - Street 1:620 W LEGGETT ST
Mailing Address - Street 2:PO BOX 150
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1348
Mailing Address - Country:US
Mailing Address - Phone:419-335-7272
Mailing Address - Fax:419-335-5564
Practice Address - Street 1:620 W LEGGETT ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1348
Practice Address - Country:US
Practice Address - Phone:419-335-7272
Practice Address - Fax:419-335-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD1600X, 261QM2500X, 261QH0100X
OH02-1518550332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies