| NPI | 1770200149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN CAPULONG CEO 330-888-2962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 251E00000X Home Health |
| 261Q00000X Clinic/Center | |
| 261QA1903X Clinic/Center Ambulatory Surgical | |
| 261QD1600X Clinic/Center Developmental Disabilities | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QM2500X Clinic/Center Medical Specialty | |
| 261QP3300X Clinic/Center Pain | |
| 261QR0400X Clinic/Center Rehabilitation | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2022-10-26 |