Healthcare Provider Details

I. General information

NPI: 1376012484
Provider Name (Legal Business Name): FHS CROSSROADS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N CASSEL RD
VANDALIA OH
45377-2926
US

IV. Provider business mailing address

25000 COUNTRY CLUB BLVD STE 255
NORTH OLMSTED OH
44070-5337
US

V. Phone/Fax

Practice location:
  • Phone: 937-898-4202
  • Fax: 937-898-8699
Mailing address:
  • Phone: 440-614-0160
  • Fax: 440-614-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL PARKER
Title or Position: PRESIDENT
Credential:
Phone: 330-554-6619