OrganizationStark Family Health CenterNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4465 Fulton Dr NW, Ste 100, Canton, OH 44718-2851(330) 497-2700PECOS EnrollmentBased on the most recent information from CMS, provider Stark Family Health Center does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1356721435Provider TypeOrganizationFull NameStark Family Health CenterSubpartNoEnumeration Date6/4/2015Last Updated6/4/2015Contact InformationPractice LocationPractice Address4465 Fulton Dr NW, Ste 100, Canton, OH 44718-2851Phone(330) 497-2700FaxUnlisted FaxMailing LocationMailing Address4465 Fulton Dr NW, Ste 100, Canton, OH 44718-2851Phone(330) 497-2700FaxUnlisted FaxAuthorized OfficialNameSwisher, Rita (Office Manager)Phone(330) 497-2700Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDST9350021DescriptionOtherIssuerMEDICARE ID-TYPE UNSPECIFIEDOhio