Healthcare Provider Details

I. General information

NPI: 1366369266
Provider Name (Legal Business Name): CHARLES TELEHA HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6361 SOUTH AVE
BOARDMAN OH
44512-3619
US

IV. Provider business mailing address

6361 SOUTH AVE
BOARDMAN OH
44512-3619
US

V. Phone/Fax

Practice location:
  • Phone: 330-599-7017
  • Fax: 330-965-1823
Mailing address:
  • Phone: 330-599-7017
  • Fax: 330-965-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberIL1640
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: