Provider Demographics
NPI:1780893644
Name:STARCHER FAMILY HOME
Entity type:Organization
Organization Name:STARCHER FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PAHANISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-698-2970
Mailing Address - Street 1:5027 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:APPLE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44606-9694
Mailing Address - Country:US
Mailing Address - Phone:330-201-0243
Mailing Address - Fax:330-698-2970
Practice Address - Street 1:5027 DOVER RD
Practice Address - Street 2:
Practice Address - City:APPLE CREEK
Practice Address - State:OH
Practice Address - Zip Code:44606-9694
Practice Address - Country:US
Practice Address - Phone:330-201-0243
Practice Address - Fax:330-698-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8510490320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2003512Medicaid
OH8500134Medicaid