Healthcare Provider Details

I. General information

NPI: 1205958519
Provider Name (Legal Business Name): FOUNDATION HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 MCCARTNEY RD
YOUNGSTOWN OH
44505-5000
US

IV. Provider business mailing address

6615 CLINGAN ROAD SUITE D
POLAND OH
44514-4202
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-4440
  • Fax: 330-743-4488
Mailing address:
  • Phone: 330-707-1425
  • Fax: 330-757-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL B EVAN
Title or Position: PRESIDENT
Credential: MD
Phone: 330-707-1425