Provider Demographics
NPI:1437943669
Name:LIFECARE FAMILY HEALTH AND DENTAL CENTER, INC
Entity type:Organization
Organization Name:LIFECARE FAMILY HEALTH AND DENTAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MBA
Authorized Official - Phone:330-454-2000
Mailing Address - Street 1:2725 LINCOLN ST E
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-2769
Mailing Address - Country:US
Mailing Address - Phone:330-454-2000
Mailing Address - Fax:
Practice Address - Street 1:715 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1128
Practice Address - Country:US
Practice Address - Phone:330-454-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)