| NPI | 1952631616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET WAGNER CEO 330-315-2666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: OH 36D0340567) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: OH 34.002564) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OH 34.002564) | |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: OH 34.002564) | |
| 208D00000X General Practice | |
| 261QC1500X Clinic/Center, Community Health (Licence: OH 34.002564) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2018-04-04 |