Provider Demographics
NPI:1881973030
Name:SHELTER CARE, INC.
Entity type:Organization
Organization Name:SHELTER CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-630-5600
Mailing Address - Street 1:32 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2802
Mailing Address - Country:US
Mailing Address - Phone:330-630-5600
Mailing Address - Fax:330-630-5810
Practice Address - Street 1:32 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2802
Practice Address - Country:US
Practice Address - Phone:330-630-5600
Practice Address - Fax:330-630-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0670251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management