Individual
SANDY HABERKOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2831 STIEGLER RD, MEDINA, OH 44256-9431
(330) 725-6025
Mailing address
2831 STIEGLER RD, MEDINA, OH 44256-9431
(330) 725-6025
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910001023569
—
IL
Enumeration date
11/29/2020
Last updated
11/29/2020
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