Provider Demographics
NPI:1649899048
Name:AMYRA SUPPORT SERVICES OF OHIO , LLC
Entity type:Organization
Organization Name:AMYRA SUPPORT SERVICES OF OHIO , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANCAR
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:216-795-5467
Mailing Address - Street 1:3513 E 113TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-1829
Mailing Address - Country:US
Mailing Address - Phone:216-860-5228
Mailing Address - Fax:
Practice Address - Street 1:11811 SHAKER BLVD STE 113D
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1927
Practice Address - Country:US
Practice Address - Phone:216-759-5467
Practice Address - Fax:216-759-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness