Provider Demographics
NPI:1568989762
Name:WOMEN'S HEALTH FOR LIFE, INC.
Entity Type:Organization
Organization Name:WOMEN'S HEALTH FOR LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KETCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-227-2727
Mailing Address - Street 1:770 W HIGH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5917
Mailing Address - Country:US
Mailing Address - Phone:419-227-2727
Mailing Address - Fax:419-224-1589
Practice Address - Street 1:1220 E ELM ST STE 204
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2898
Practice Address - Country:US
Practice Address - Phone:419-224-2632
Practice Address - Fax:419-224-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty