Healthcare Provider Details

I. General information

NPI: 1538053863
Provider Name (Legal Business Name): KELLY FANGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3966 WARRENSVILLE CENTER RD
BEACHWOOD OH
44122-6770
US

IV. Provider business mailing address

5900 LANDERBROOK DR STE 301
MAYFIELD HEIGHTS OH
44124-4020
US

V. Phone/Fax

Practice location:
  • Phone: 440-340-5086
  • Fax: 440-340-5035
Mailing address:
  • Phone: 216-972-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2604986-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: