Provider Demographics
NPI:1548710866
Name:DIVERSIFIED HEALTH CARE INC.
Entity type:Organization
Organization Name:DIVERSIFIED HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:POGORELEC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-836-4466
Mailing Address - Street 1:1708 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5252
Mailing Address - Country:US
Mailing Address - Phone:330-836-4466
Mailing Address - Fax:
Practice Address - Street 1:1708 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5252
Practice Address - Country:US
Practice Address - Phone:330-836-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.002769208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0395246Medicaid
OHPO0463543Medicare PIN
OHA78779Medicare UPIN