Healthcare Provider Details

I. General information

NPI: 1942397591
Provider Name (Legal Business Name): CHILD HEALTH SERVICES OF PORTAGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S MERIDIAN ST
RAVENNA OH
44266-2914
US

IV. Provider business mailing address

449 S MERIDIAN ST
RAVENNA OH
44266-2914
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-5437
  • Fax: 330-297-4556
Mailing address:
  • Phone: 330-297-5437
  • Fax: 330-297-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number0453049
License Number StateOH

VIII. Authorized Official

Name: MRS. RUTH CARNES
Title or Position: DIRECTOR
Credential:
Phone: 330-297-5437