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General NPI Number Information
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NPI Number | 1659146884
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Entity Type | Organization
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Legal Business Name | MY COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 1318 GONDER AVE SE UNIT 1
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City | CANTON
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State | OH
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Zip | 44707-3450
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Country | US
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Telephone | 330-639-1071
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Fax | 330-639-1072
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Provider Business Mailing Address
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Address Line | 2600 7TH ST. SW
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City | CANTON
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State | OH
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Zip | 44710
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Country | US
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Telephone | 330-363-2218
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JUAN PAULO AFABLE
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Credential |
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Telephone | 330-363-3786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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