Provider Demographics
NPI:1619090891
Name:FOUNDATION HEALTH CARE, INC.
Entity Type:Organization
Organization Name:FOUNDATION HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-707-1425
Mailing Address - Street 1:6615 CLINGAN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2196
Mailing Address - Country:US
Mailing Address - Phone:330-707-1425
Mailing Address - Fax:330-757-2814
Practice Address - Street 1:755 BOARDMAN-CANFILED ROAD
Practice Address - Street 2:SUITE F5
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514
Practice Address - Country:US
Practice Address - Phone:330-726-3806
Practice Address - Fax:330-726-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFO9371331OtherPTAN
1083828974OtherNPI
1467436261OtherNPI
1083828974OtherNPI
OH9371331Medicare PIN