MEDICARE: DOMESTIC VIOLENCE PROJECT, 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	261QM0850X	Adult Mental Health Clinic/Center	0705	OH

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	:	1376982736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMESTIC VIOLENCE PROJECT, INC

Provider Business Mailing Address
First Line	:	PO BOX 9459
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44711-9459
Country	:	US
Telephone Number	:	330-445-2001
Fax Number	:	330-445-2007

Provider Business Practice Location Address
First Line	:	720 19TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-2213
Country	:	US
Telephone Number	:	330-491-1351
Fax Number	:	330-491-9720

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/CEO
Name	:	MS. MELISSA L PEARCE
Credential	:
Telephone Number	:	330-445-2001

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	06/19/2013

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Directions to “DOMESTIC VIOLENCE PROJECT, INC ” Practice Location

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