Provider Demographics
NPI:1639135940
Name:FAR WEST CENTER
Entity Type:Organization
Organization Name:FAR WEST CENTER
Other - Org Name:SUBPART LOCATION - AMHERST
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF FINANCIAL SYSTEMS
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:FAYETTE
Authorized Official - Last Name:RADOCAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-835-6212
Mailing Address - Street 1:29133 HEALTH CAMPUS DR
Mailing Address - Street 2:BLDG. 4
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5256
Mailing Address - Country:US
Mailing Address - Phone:440-835-6212
Mailing Address - Fax:440-835-6231
Practice Address - Street 1:554 N LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1131
Practice Address - Country:US
Practice Address - Phone:440-988-4900
Practice Address - Fax:440-988-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308483Medicaid
OH9913513Medicare ID - Type UnspecifiedMEDICARE - AMHERST
OH10460Medicare UPIN