Provider Demographics
NPI:1982748414
Name:TOTAL LIVING CENTER FREE CLINIC
Entity Type:Organization
Organization Name:TOTAL LIVING CENTER FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-478-0400
Mailing Address - Street 1:2221 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706
Mailing Address - Country:US
Mailing Address - Phone:330-478-0400
Mailing Address - Fax:
Practice Address - Street 1:2221 9TH ST SW FREE CLINIC
Practice Address - Street 2:2221 9TH ST SW
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706
Practice Address - Country:US
Practice Address - Phone:330-455-3663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHO13679261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0842182Medicaid