NPIMap

Organization Active NPI

Lifecare Family Health and Dental Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Massillon, OH
National Provider Identifier
1134959000
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LIFECARE FAMILY HEALTH AND DENTAL CENTER, INC
Practice address
830 Amherst Rd NE
Massillon, OH 44646-8518
Phone
(330) 454-2000
NPI assigned
Aug 6, 2024
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eric Niemeyer
Title
Ceo
Phone
(330) 454-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

830 Amherst Rd NE
Massillon, OH 44646-8518

Mailing address

2725 Lincoln St E
Canton, OH 44707-2769
Phone (330) 454-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131031001454 OH Part B Supplier - Clinic/Group Practice 7315959483 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Massillon, OH; Canton, OH
O20240905001636 OH Part A Provider - Federally Qualified Health Center (FQHC) 7315959483 Practice locations: Massillon, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134959000. Details of each certification follow.

Federally qualified health center certification: CCN D21049

Legal name
LIFECARE FAMILY HEALTH AND DENTAL CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 4, 2024
Last certification
Sep 4, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 3, 1992 in OH
Enrollment address
830 Amherst Rd NE
Massillon, OH 44646

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Canton Community Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1950 Tuscarawas St E
Canton, OH 44707
Phone (330) 224-1594

408 9th St SW
Canton, OH 44707
Phone (330) 454-2000

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Eric Niemeyer Individual Corporate DirectorCeo Feb 4, 2022
W-2 Managing EmployeeCeo Feb 4, 2022
Dean Varian Individual Corporate OfficerChairman Oct 1, 2016
Corporate DirectorBoard Member Oct 1, 2016
Barbara Frustaci Individual Corporate OfficerChairman Jan 25, 2018
Corporate DirectorBoard Member Jan 25, 2018
Kelly Henley Individual Corporate OfficerTreasurer Jan 1, 2019
Corporate DirectorBoard Member Jan 1, 2019
George Crues Individual Corporate OfficerVice Chairman Jan 1, 2020
Corporate DirectorBoard Member Jan 1, 2020
Zach Hostetler Individual Corporate DirectorBoard Member Jan 1, 2019
Lora Harley Individual Corporate Officer Jan 1, 2023
Rebecca Johnson Individual Corporate DirectorBoard Member Jan 1, 2021
Terrance L Jones Individual Corporate Director Jan 1, 2021
Rebekka Russell Individual Corporate DirectorBoard Member May 26, 2022
Gail Tarantino Individual Corporate DirectorBoard Member Jul 23, 2020
Allana Haut Individual Corporate DirectorBoard Member Jun 26, 2015

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1134959000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 LINCOLN ST E",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447072769",
            "telephone_number": "330-454-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 AMHERST RD NE",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446468518",
            "telephone_number": "330-454-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE FAMILY HEALTH AND DENTAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "NIEMEYER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-454-2000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massillon, OH

Sources for this page

Verify at the official NPI Registry.