MEDICARE: WEAVER INDUSTRIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033712559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEAVER INDUSTRIES, INC.

Provider Business Mailing Address
First Line	:	520 S MAIN ST STE 2441
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1071
Country	:	US
Telephone Number	:	330-379-3660
Fax Number	:	330-379-3665

Provider Business Practice Location Address
First Line	:	520 S MAIN ST STE 2441
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1071
Country	:	US
Telephone Number	:	330-379-3660
Fax Number	:	330-379-3665

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS & FINANCE
Name	:	MRS. CARLA MCDONALD
Credential	:
Telephone Number	:	330-379-3660

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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