Provider Demographics
NPI:1366485567
Name:LIFE STAGES WOMENS HEALTH & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:LIFE STAGES WOMENS HEALTH & WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLAIMS PROCESSOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-479-8705
Mailing Address - Street 1:2606 WALES ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-832-7302
Mailing Address - Fax:330-832-7325
Practice Address - Street 1:2606 WALES ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646
Practice Address - Country:US
Practice Address - Phone:330-832-7302
Practice Address - Fax:330-832-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330909Medicaid
OHH51249Medicare UPIN
OH2330909Medicaid