Healthcare Provider Details

I. General information

NPI: 1972784734
Provider Name (Legal Business Name): LIVING WELL FAMILY PRACTICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PL SUITE 1650
BOARDMAN OH
44512-7004
US

IV. Provider business mailing address

250 DEBARTOLO PL SUITE 1650
BOARDMAN OH
44512-7004
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-9355
  • Fax: 330-726-9444
Mailing address:
  • Phone: 330-726-9355
  • Fax: 330-726-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-05-95666
License Number StateOH

VIII. Authorized Official

Name: MRS. ERRIN CHRISTINE WILLIAMS
Title or Position: OFFICE MANAGER
Credential: CMA
Phone: 330-726-9355