Healthcare Provider Details

I. General information

NPI: 1861419814
Provider Name (Legal Business Name): YOUNGSTOWN AREA JEWISH FEDERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 GYPSY LN
YOUNGSTOWN OH
44504-1314
US

IV. Provider business mailing address

517 GYPSY LN
YOUNGSTOWN OH
44504-1314
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-6300
  • Fax: 330-746-7926
Mailing address:
  • Phone: 330-884-6300
  • Fax: 330-746-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3234
License Number StateOH

VIII. Authorized Official

Name: DAVID JOHN STAUFFER
Title or Position: CFO
Credential: CPA
Phone: 330-397-8025