Healthcare Provider Details

I. General information

NPI: 1578420451
Provider Name (Legal Business Name): WILLIAM CHOOSE ONE CARPENTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 44TH ST
ASHTABULA OH
44004-6812
US

IV. Provider business mailing address

620 W 44TH ST
ASHTABULA OH
44004-6812
US

V. Phone/Fax

Practice location:
  • Phone: 440-650-5030
  • Fax: 440-650-5030
Mailing address:
  • Phone: 440-650-5030
  • Fax: 440-650-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: