Healthcare Provider Details

I. General information

NPI: 1700715240
Provider Name (Legal Business Name): CANTERBURY HOUSE DIRECT PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 STATION ST STE 270
MENTOR OH
44060-4943
US

IV. Provider business mailing address

8500 STATION ST STE 270
MENTOR OH
44060-4943
US

V. Phone/Fax

Practice location:
  • Phone: 440-641-4146
  • Fax: 440-596-4633
Mailing address:
  • Phone: 440-641-4146
  • Fax: 440-596-4633

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: SARAH WATSON
Title or Position: OWNER
Credential: DO
Phone: 440-641-4146