Healthcare Provider Details

I. General information

NPI: 1770698466
Provider Name (Legal Business Name): CHILDREN'S CARE CENTER FOR BLOOD & CANCER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-3955
  • Fax: 330-884-3861
Mailing address:
  • Phone: 330-884-3955
  • Fax: 330-884-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LUCINE SALEH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 330-884-3955