Healthcare Provider Details

I. General information

NPI: 1790808970
Provider Name (Legal Business Name): EAST HOLMES FAMILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 TR 661
DUNDEE OH
44624
US

IV. Provider business mailing address

PO BOX 366
BERLIN OH
44610
US

V. Phone/Fax

Practice location:
  • Phone: 330-359-5989
  • Fax: 330-359-3590
Mailing address:
  • Phone: 330-359-5989
  • Fax: 330-359-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT KIM KORNHAUS
Title or Position: TREASURER-PHYSICIAN
Credential: MD
Phone: 330-893-3771