Healthcare Provider Details

I. General information

NPI: 1891621850
Provider Name (Legal Business Name): MARLAC HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3755 SUGARBUSH DR
CANFIELD OH
44406-9107
US

IV. Provider business mailing address

3755 SUGARBUSH DR
CANFIELD OH
44406-9107
US

V. Phone/Fax

Practice location:
  • Phone: 330-519-4789
  • Fax:
Mailing address:
  • Phone: 330-519-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEAN CICORETTI
Title or Position: MANAGING MEMBER
Credential:
Phone: 330-519-4789