Healthcare Provider Details

I. General information

NPI: 1568646560
Provider Name (Legal Business Name): FAMILY HEALTH CARE OF NORTHWEST OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 WESTWOOD DR
VAN WERT OH
45891-2464
US

IV. Provider business mailing address

1191 WESTWOOD DR
VAN WERT OH
45891-2464
US

V. Phone/Fax

Practice location:
  • Phone: 419-268-6747
  • Fax: 419-238-3721
Mailing address:
  • Phone: 419-238-6747
  • Fax: 419-238-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberE.1300033
License Number StateOH

VIII. Authorized Official

Name: MRS. JENNIFER L SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 419-238-6747