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General NPI Number Information
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NPI Number | 1972788768
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Entity Type | Organization
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Legal Business Name | FOUR COUNTY FAMILY CENTER
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 7320 STATE HIGHWAY 108
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City | WAUSEON
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State | OH
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Zip | 43567-8200
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Country | US
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Telephone | 419-335-3462
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Fax | 419-335-3462
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Provider Business Mailing Address
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Address Line | 7320 STATE HIGHWAY 108
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City | WAUSEON
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State | OH
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Zip | 43567-8200
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Country | US
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Telephone | 419-335-3462
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Fax | 419-335-3462
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Authorized Official
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Title or Position | NURSE
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Name | MS. BEVERLY ANN HEFFLINGER
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Credential | LPN
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Telephone | 419-335-3732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | PN088950
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License Number State | OH
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