Most Relevant Information
Provider Data
| NPI Number: | 1003504440 |
| Provider Name: | CHARLES THERONE MACK |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/25/2023 |
| Last Updated: | 04/25/2023 |
Provider Practice Location
500 MADISON AVE
TOLEDO
OH
436041222
Practice Location Phone/Fax
| Phone: | 5673128700 |
| Fax: | 5673128793 |
Provider Mailing Location
1013 JUNCTION AVE
TOLEDO
OH
436074051
Provider Mailing Phone/Fax
| Phone: | 5672889674 |
| Fax: |