Provider Demographics
NPI:1023526043
Name:FAMILY HEALTHCARE PARTNERS
Entity type:Organization
Organization Name:FAMILY HEALTHCARE PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEROY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:740-891-8479
Mailing Address - Street 1:2085 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9273
Mailing Address - Country:US
Mailing Address - Phone:740-891-8479
Mailing Address - Fax:
Practice Address - Street 1:145 SUNRISE CENTER DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4650
Practice Address - Country:US
Practice Address - Phone:740-891-8479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH285239251G00000X, 261QU0200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251G00000XAgenciesHospice Care, Community Based
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062365Medicaid