Organization
LIFECARE FAMILY HEALTH AND DENTAL CENTER, INC
Active
Other names
Canton Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN SEEBERGER (CHIEF EXECUTIVE OFFICER)
(330) 454-2000
Entity
Organization
Contact information
Practice address
2725 LINCOLN ST E, CANTON, OH 44707-2769
(330) 454-2000
(330) 454-7284
Mailing address
2725 LINCOLN ST E, CANTON, OH 44707-2769
(330) 454-2000
(330) 454-7284
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2676288
—
OH
01
—
3619131
MEDICARE PART B
—
Enumeration date
05/27/2006
Last updated
05/02/2019
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