Provider Demographics
NPI:1710625306
Name:JOY D FRUCHEY AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JOY D FRUCHEY AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-343-6068
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-0293
Mailing Address - Country:US
Mailing Address - Phone:567-343-6068
Mailing Address - Fax:
Practice Address - Street 1:850 W ELM ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1189
Practice Address - Country:US
Practice Address - Phone:567-343-6068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210958Medicaid