Healthcare Provider Details

I. General information

NPI: 1336058619
Provider Name (Legal Business Name): FAMCO HUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 RICHMOND ST # 1009
PAINESVILLE OH
44077-3254
US

IV. Provider business mailing address

167 RICHMOND ST # 1009
PAINESVILLE OH
44077-3254
US

V. Phone/Fax

Practice location:
  • Phone: 808-320-2611
  • Fax:
Mailing address:
  • Phone: 808-320-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY GOODWIN
Title or Position: OWNER
Credential:
Phone: 808-320-2611