Individual

NPI #1962958512 in Canton, Ohio

Provider Information

NPI Number: 1962958512
Entity Type: Organization
Organization Name: Individual
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 1, 2016
Last Updated: Sep 1, 2016

Practice Location

Address: 1111 GONDER AV SE
City: Canton
State: Ohio
ZIP Code: 44707
Phone: (330) 265-7902

Authorized Official

Name: MISS TAMMIE LYNN MAYLE
Title: HOME HEALTH AID
Phone: (330) 265-7902

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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