Healthcare Provider Details

I. General information

NPI: 1639135940
Provider Name (Legal Business Name): FAR WEST CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 N LEAVITT RD
AMHERST OH
44001-1131
US

IV. Provider business mailing address

29133 HEALTH CAMPUS DR BLDG. 4
WESTLAKE OH
44145-5256
US

V. Phone/Fax

Practice location:
  • Phone: 440-988-4900
  • Fax: 440-988-4910
Mailing address:
  • Phone: 440-835-6212
  • Fax: 440-835-6231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0308483
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: MR. DANIEL FAYETTE RADOCAJ
Title or Position: VP OF FINANCIAL SYSTEMS
Credential:
Phone: 440-835-6212