Provider Demographics
NPI:1518757558
Name:
Entity type:Organization
Organization Name:
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CLASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-619-4363
Mailing Address - Street 1:5522 CARY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4786
Mailing Address - Country:US
Mailing Address - Phone:614-619-4363
Mailing Address - Fax:
Practice Address - Street 1:5522 CARY LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4786
Practice Address - Country:US
Practice Address - Phone:614-619-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care