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NPI Code Detail

MEDICARE: COMMUNITY WELLNESS CENTER OF STARK COUNTY, INC.

MEDICARE: COMMUNITY WELLNESS CENTER OF STARK COUNTY, 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
1251B00000XCase Management Agency

General Provider Information

NPI Number : 1164593455
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY WELLNESS CENTER OF STARK COUNTY, INC.
Provider Business Mailing Address
First Line : 1800 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44709-3602
Country : US
Telephone Number : 330-456-7792
Fax Number : 330-456-7061
Provider Business Practice Location Address
First Line : 1800 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44709-3602
Country : US
Telephone Number : 330-456-7792
Fax Number : 330-456-7061
Authorized Official
Title or Position : CEO EXECUTIVE DIRECTOR
Name : KELLI J SCOTT
Credential : MS
Telephone Number : 330-456-7792
Provider Enumeration Date : 11/10/2006
Last Update Date : 08/22/2020

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Directions to “COMMUNITY WELLNESS CENTER OF STARK COUNTY, INC. ” Practice Location

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