Provider Demographics
NPI:1588950463
Name:FASCINATIONS
Entity type:Organization
Organization Name:FASCINATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELESHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-252-7229
Mailing Address - Street 1:443 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2134
Mailing Address - Country:US
Mailing Address - Phone:330-475-1555
Mailing Address - Fax:330-475-1560
Practice Address - Street 1:443 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2134
Practice Address - Country:US
Practice Address - Phone:330-475-1555
Practice Address - Fax:330-475-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center