1730374687 NPI number — COMMUNITY FAMILY CARE INC

Table of content: (NPI 1730374687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730374687 NPI number — COMMUNITY FAMILY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY FAMILY CARE INC
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:
1730374687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1966
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELYRIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44036-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-366-5600
Provider Business Mailing Address Fax Number:
440-366-6766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2217 WISTERIA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44011-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-934-7080
Provider Business Practice Location Address Fax Number:
440-934-0810
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAYBER
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-934-7080

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080190847 . This is a "PALMETTO GBA RETIRED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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