Organization
SUPPORTCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN COLLERAN (PRESIDENT)
(440) 614-0160
Entity
Organization
Contact information
Practice address
22021 BROOKPARK RD, STE 123, FAIRVIEW PARK, OH 44126-3100
(440) 614-0160
(440) 614-0168
Mailing address
22021 BROOKPARK RD, STE 123, FAIRVIEW PARK, OH 44126-3100
(440) 614-0160
(440) 614-0168
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
4501766
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4500552
—
OH
Enumeration date
11/30/2006
Last updated
01/22/2008
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