Healthcare Provider Details

I. General information

NPI: 1235898321
Provider Name (Legal Business Name): FAMILY HEALTH SERVICES OF ERIE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTER ST
BERLIN HEIGHTS OH
44814-9603
US

IV. Provider business mailing address

1912 HAYES AVE STE D
SANDUSKY OH
44870-4736
US

V. Phone/Fax

Practice location:
  • Phone: 419-502-2800
  • Fax:
Mailing address:
  • Phone: 419-502-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DAVID TATRO
Title or Position: CEO
Credential:
Phone: 419-502-2822