Healthcare Provider Details

I. General information

NPI: 1437796117
Provider Name (Legal Business Name): OHIO LIVING PALLIATIVE CARE GREATER AKRON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 N MILLER RD STE 101
FAIRLAWN OH
44333-3729
US

IV. Provider business mailing address

1001 KINGSMILL PKWY
COLUMBUS OH
43229-1129
US

V. Phone/Fax

Practice location:
  • Phone: 330-873-3468
  • Fax: 330-873-3465
Mailing address:
  • Phone: 614-888-7800
  • Fax: 614-888-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT B. STILLMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 614-888-7800