Provider Demographics
NPI:1669086260
Name:FAMILY CARE PLUS CLINIC LLC
Entity type:Organization
Organization Name:FAMILY CARE PLUS CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-765-4141
Mailing Address - Street 1:4490 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1885
Mailing Address - Country:US
Mailing Address - Phone:330-765-4141
Mailing Address - Fax:
Practice Address - Street 1:297 N MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1077
Practice Address - Country:US
Practice Address - Phone:330-765-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0382952Medicaid
OH0421076Medicaid