| Details | Last Recertification Date | Update | Recertification | 2/7/2024 8:47:58 AM | 2/13/2025 8:19:49 AM | 2/13/2025 8:19 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2023 4:09:49 PM | 2/7/2024 8:47:58 AM | 2/7/2024 8:47 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2022 8:37:59 AM | 2/3/2023 4:09:49 PM | 2/3/2023 4:09 PM |
| Contacts | Authorizing Official | Update | Group Change Request | McPeek, Janet C
CEO
Lifecare Family Health and Dental Center, Inc.
2345217213 | Niemeyer, Eric
CEO
Lifecare Family Health & Dental Center, Inc
3304542000-150 | 1/19/2023 8:10 AM |
| Details | Last Recertification Date | Update | Recertification | 2/11/2021 8:45:30 AM | 2/7/2022 8:37:59 AM | 2/7/2022 8:37 AM |
| Contacts | Primary Contact | Update | Change Request | Trieff, Jan
Clinic Coordinator
Lifecare Family Health & Dental Center
3304542000-189 | Johnson, Patricia
CFO
Lifecare Family Health and Dental Center, Inc.
3304542000-214 | 10/12/2021 12:25 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | McPeek, Janet C
CFO
Lifecare Family Health and Dental Center, Inc.
2345217213 | McPeek, Janet C
CEO
Lifecare Family Health and Dental Center, Inc.
2345217213 | 10/7/2021 12:23 PM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2020 10:25:25 AM | 2/11/2021 8:45:30 AM | 2/11/2021 8:45 AM |
| Details | Entity Name | Update | Change Request | RICHARD D WATKINS CANTON COMMUNITY CLINIC INC | Lifecare Family Health & Dental Center, Inc. | 7/29/2020 7:02 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 0099810 (OH) | | 7/9/2020 10:14 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1851592034 ( ) | | 7/9/2020 10:14 AM |
| Contacts | Authorizing Official | Update | Change Request | Scarp, Kay
CEO
Lifecare Family Health & Dental Center
3304542000-212 | McPeek, Janet C
CFO
Lifecare Family Health and Dental Center, Inc.
2345217213 | 7/8/2020 7:14 AM |
| Contacts | Primary Contact | Update | Change Request | McPeek, Janet C
CFO
Lifecare Family Health and Dental Center, Inc.
2345217213 | Trieff, Jan
Clinic Coordinator
Lifecare Family Health & Dental Center
3304542000-189 | 7/8/2020 7:14 AM |
| Details | Last Recertification Date | Update | Recertification | 2/25/2019 9:13:47 AM | 2/19/2020 10:25:25 AM | 2/19/2020 10:25 AM |
| Details | Last Recertification Date | Update | Recertification | 3/7/2018 3:45:52 PM | 2/25/2019 9:13:47 AM | 2/25/2019 9:13 AM |
| Contacts | Primary Contact | Update | Recertification | GLEW, JOAN
CLINICAL COORDINATOR
3304542000-228 | McPeek, Janet C
CFO
Lifecare Family Health and Dental Center, Inc.
2345217213 | 3/7/2018 3:45 PM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2017 12:00:00 AM | 3/7/2018 3:45:52 PM | 3/7/2018 3:45 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 3/7/2018 3:45 PM |
| Contacts | Authorizing Official | Update | | Scarp, Kay
CEO
3304542000-212 | Scarp, Kay
CEO
Lifecare Family Health & Dental Center
3304542000-212 | 3/5/2018 10:14 AM |
| Addresses | Main Address | Insert | | |
408 9th St SW
Canton, OH 44707-4714 | 2/20/2017 7:27 AM |
| Contacts | Primary Contact | Update | | Glew, Joan
Clinic Coordinator
3304542000-228 | GLEW, JOAN
CLINICAL COORDINATOR
3304542000-228 | 2/20/2017 7:27 AM |
| Contacts | Authorizing Official | Insert | | | Scarp, Kay
CEO
3304542000-212 | 2/20/2017 7:27 AM |
| Contacts | Signed By | Insert | | | Cola, David
CMO CEO
3304542000 | 2/20/2017 7:27 AM |
| Details | Last Recertification Date | Update | | 3/7/2016 12:00:00 AM | 2/14/2017 12:00:00 AM | 2/20/2017 7:27 AM |
| Details | Last Recertification Date | Update | | 3/3/2015 12:00:00 AM | 3/7/2016 12:00:00 AM | 3/7/2016 7:45 AM |
| Details | Last Recertification Date | Update | | | 3/3/2015 12:00:00 AM | 3/3/2015 9:21 AM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 3/3/2015 9:21 AM |
| Contacts | Primary Contact | Insert | | | Glew, Joan
Clinic Coordinator
3304542000-228 | 6/18/2014 1:46 PM |
| Details | 340B ID | Update | | ONLINE_REG | CH053086C | 4/30/2014 5:33 PM |
| Dates | Participating Approval Date | Update | | | 4/30/2014 12:00:00 AM | 4/30/2014 5:33 PM |
| Details | State | Update | | Pending | Active | 4/30/2014 5:33 PM |
| Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 4/30/2014 5:33 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/11/2014 9:57 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 0099810 | 4/11/2014 9:57 AM |
| Medicaid Billing | Medicaid: State | Insert | | | OH | 4/11/2014 9:57 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1851592034 | 4/11/2014 9:57 AM |
| Details | Last Recertification Date | Insert | | | | 4/11/2014 9:57 AM |
| Details | Grant Number | Insert | | | H80CS06654 | 4/11/2014 9:57 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/11/2014 9:57 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/11/2014 9:57 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/11/2014 9:57 AM |
| Details | Medicare Provider Number | Insert | | | | 4/11/2014 9:57 AM |
| Details | Entity Name | Insert | | | RICHARD D WATKINS CANTON COMMUNITY CLINIC INC | 4/11/2014 9:57 AM |
| Details | Program Code | Insert | | | CH | 4/11/2014 9:57 AM |
| Details | Entity Subname | Insert | | | 9th Street Family Health Center | 4/11/2014 9:57 AM |
| Dates | Participating Approval Date | Insert | | | | 4/11/2014 9:57 AM |
| Details | State | Insert | | | Pending | 4/11/2014 9:57 AM |
| Dates | Registration Date | Insert | | | 4/11/2014 12:00:00 AM | 4/11/2014 9:57 AM |
| Dates | Signed By Date | Insert | | | 4/11/2014 12:00:00 AM | 4/11/2014 9:57 AM |
| Dates | Start Date | Insert | | | | 4/11/2014 9:57 AM |
| Terminations | Termination Comments | Insert | | | | 4/11/2014 9:57 AM |
| Terminations | Termination Date | Insert | | | | 4/11/2014 9:57 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/11/2014 9:57 AM |
| Terminations | Termination Reason | Insert | | | | 4/11/2014 9:57 AM |