Provider Demographics
NPI:1578083234
Name:HEART OF OHIO FAMILY HEALTH CENTERS
Entity Type:Organization
Organization Name:HEART OF OHIO FAMILY HEALTH CENTERS
Other - Org Name:HEART OF OHIO FAMILY HEALTH @ CANAL WINCHESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:YAMMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-235-5555
Mailing Address - Street 1:PO BOX 632127
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3003
Mailing Address - Country:US
Mailing Address - Phone:614-235-5555
Mailing Address - Fax:614-536-1994
Practice Address - Street 1:3601 GENDER RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9739
Practice Address - Country:US
Practice Address - Phone:614-235-5555
Practice Address - Fax:614-536-1994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART OF OHIO FAMILY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2913066Medicaid
OH0265791Medicaid