Organization
STANLEY FULLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANLEY B FULLER (LPN)
(419) 307-2984
Entity
Organization
Contact information
Practice address
117 N WAYNE ST, FREMONT, OH 43420-2431
(419) 307-2984
Mailing address
117 N WAYNE ST, FREMONT, OH 43420-2431
(419) 307-2984
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
PN 102037
OH
Other
Enumeration date
11/28/2007
Last updated
11/28/2007
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