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General NPI Number Information
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NPI Number | 1053565986
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Entity Type | Organization
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Legal Business Name | FAMILY STATCARE OF NORTHEAST OHIO, LLC
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 175 GREAT OAKS TRL
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City | WADSWORTH
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State | OH
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Zip | 44281-8712
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Country | US
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Telephone | 330-336-3588
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Fax | 330-336-1328
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Provider Business Mailing Address
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Address Line | 230 QUADRAL DR SUITE B
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City | WADSWORTH
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State | OH
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Zip | 44281-8376
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Country | US
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Telephone | 330-336-3280
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Fax | 330-336-5325
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Authorized Official
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Title or Position | OWNER
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Name | KEN FILBERT
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Credential |
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Telephone | 330-416-6153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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