Provider Demographics
NPI:1972788768
Name:FOUR COUNTY FAMILY CENTER
Entity Type:Organization
Organization Name:FOUR COUNTY FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEFFLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:419-335-3732
Mailing Address - Street 1:7320 STATE HIGHWAY 108
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-8200
Mailing Address - Country:US
Mailing Address - Phone:419-335-3462
Mailing Address - Fax:419-335-3462
Practice Address - Street 1:7320 STATE HIGHWAY 108
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8200
Practice Address - Country:US
Practice Address - Phone:419-335-3462
Practice Address - Fax:419-335-3462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SERVICES OF NWO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN088950251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN088950OtherLPN LICENSURE