Healthcare Provider Details

I. General information

NPI: 1659979219
Provider Name (Legal Business Name): FAMILY HEALTH SERVICES OF ERIE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BENEDICT AVE
NORWALK OH
44857-2346
US

IV. Provider business mailing address

1912 HAYES AVE
SANDUSKY OH
44870-4736
US

V. Phone/Fax

Practice location:
  • Phone: 419-502-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DAVID TATRO
Title or Position: CEO
Credential:
Phone: 419-502-2822