# STANLEY FULLER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073795423
- **Authorized official:** MR. STANLEY B FULLER (LPN)
- **Authorized official phone:** (419) 307-2984

## Contact information

- **Practice address:** 117 N WAYNE ST, FREMONT, OH 43420-2431
- **Practice address phone:** (419) 307-2984
- **Mailing address:** 117 N WAYNE ST, FREMONT, OH 43420-2431
- **Mailing address phone:** (419) 307-2984

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | PN 102037 | OH | Yes |

## Other

- **Enumeration date:** 11/28/2007
- **Last updated:** 11/28/2007