Courtney J Srihavong | Toledo, OH • PECOS Search

Courtney J Srihavong

Community/Behavioral Health

Agencies

1832 Adams St, Toledo, OH 43604-4428

PECOS Enrollment

Based on the most recent information from CMS, provider Courtney J Srihavong does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1306476551
Provider Type
Individual
Full Name
Srihavong, Courtney J
Gender
Female

Sole Proprietor
Yes
Enumeration Date
1/16/2020
Last Updated
1/16/2020

Contact Information

Practice Location

1832 Adams St, Toledo, OH 43604-4428

Unlisted Fax

Mailing Location

3611 Prairie Ave, Toledo, OH 43614-5141

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 251S00000X Primary	Description Community/Behavioral Health Agencies	License Unlisted Issuer