Provider Demographics
NPI:1912542432
Name:SILVER FAMILY CARE CENTER LLC
Entity Type:Organization
Organization Name:SILVER FAMILY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:513-432-2899
Mailing Address - Street 1:2336 MACK RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-322-2098
Mailing Address - Fax:513-855-2021
Practice Address - Street 1:2336 MACK RD UNIT B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3169
Practice Address - Country:US
Practice Address - Phone:513-322-2098
Practice Address - Fax:513-855-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0151853Medicaid