Healthcare Provider Details

I. General information

NPI: 1881574424
Provider Name (Legal Business Name): FSR OF PARKMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 YOUNGSTOWN RD SE STE A
WARREN OH
44484-4402
US

IV. Provider business mailing address

2507 YOUNGSTOWN RD SE STE A
WARREN OH
44484-4402
US

V. Phone/Fax

Practice location:
  • Phone: 330-369-8022
  • Fax:
Mailing address:
  • Phone: 330-369-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MERRITT
Title or Position: COMPLIANCE DIRECTOR
Credential:
Phone: 330-369-8022