Provider Demographics
NPI:1336542539
Name:SUPPORT FOR YOU
Entity Type:Organization
Organization Name:SUPPORT FOR YOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-567-8123
Mailing Address - Street 1:89 HELENE DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5377
Mailing Address - Country:US
Mailing Address - Phone:440-567-8123
Mailing Address - Fax:
Practice Address - Street 1:89 HELENE DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-5377
Practice Address - Country:US
Practice Address - Phone:440-567-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4302721Medicaid