Provider Demographics
NPI:1679542021
Name:STAFFORD SERVICES, INC.
Entity Type:Organization
Organization Name:STAFFORD SERVICES, INC.
Other - Org Name:ORCHARD HEALTH PROFESSIONALS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-898-8399
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-898-8399
Mailing Address - Fax:216-362-0677
Practice Address - Street 1:12380 PLAZA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:216-898-8399
Practice Address - Fax:216-362-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09247363LA2200X
OHNP-05095363LA2200X
OHNP-00370363LA2200X
OHNP-08145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2647621Medicaid
OH2647621Medicaid