Organization Name: | AMERICAN FAMILY CARE OHIO, LLC |
NPI Number: | 1629436431 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RANDY JOHANSEN (PRESIDENT) |
Mailing Address: | 3802 Paxton Ave Ste. 1 Cincinnati |
State: | OH US |
Postal Code: | 452092399 |
Phone Number: | 5135599700 |
Fax Number: | 5135590900 |
NPI Enumeration Date: | 02/08/2016 |
NPI Last Update Date: | 02/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |