Provider Demographics
NPI:1164695789
Name:FAMILY PLANNING ASSOCIATION OF NORTHEAST OHIO, INC.
Entity Type:Organization
Organization Name:FAMILY PLANNING ASSOCIATION OF NORTHEAST OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE-PEASPANEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CHES
Authorized Official - Phone:440-352-0608
Mailing Address - Street 1:54 S STATE ST
Mailing Address - Street 2:STE 203
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3445
Mailing Address - Country:US
Mailing Address - Phone:440-352-0608
Mailing Address - Fax:
Practice Address - Street 1:510 W 44TH ST
Practice Address - Street 2:STE 2
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6889
Practice Address - Country:US
Practice Address - Phone:440-992-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PLANNING ASSOCIATION OF NORTHEAST OHIO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-03
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0765515Medicaid