Healthcare Provider Details

I. General information

NPI: 1588117147
Provider Name (Legal Business Name): MY COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 7TH ST SW
CANTON OH
44710-1709
US

IV. Provider business mailing address

2600 7TH ST SW
CANTON OH
44710-1709
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-6211
  • Fax:
Mailing address:
  • Phone: 330-363-2218
  • Fax: 330-363-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUAN PAULO AFABLE
Title or Position: CEO
Credential:
Phone: 330-363-3786