1265422513 NPI number — FORUM HEALTH ENTERPRISES

Table of content: (NPI 1265422513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265422513 NPI number — FORUM HEALTH ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORUM HEALTH ENTERPRISES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265422513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44501-1113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-884-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 BOARDMAN CANFIELD RD
Provider Second Line Business Practice Location Address:
BLDG P SUITE#1
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-726-5500
Provider Business Practice Location Address Fax Number:
330-726-0155
Provider Enumeration Date:
10/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAGPAUL
Authorized Official First Name:
AMARJEET
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR OF NEUROLOGY
Authorized Official Telephone Number:
330-726-5500

Provider Taxonomy Codes

  • Taxonomy code: 204C00000X , with the licence number:  35-04-0484 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 35-04-0484 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 03522292 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".