MEDICARE: NORTH CANTON PLAYHOUSE SPOTLIGHT ON YOUTH

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1639146574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CANTON PLAYHOUSE SPOTLIGHT ON YOUTH

Provider Business Mailing Address
First Line	:	1127 E MAPLE ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2678
Country	:	US
Telephone Number	:	330-494-3423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 E MAPLE ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2678
Country	:	US
Telephone Number	:	330-494-3423
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ERA LYNN TRIPP
Credential	:	ED
Telephone Number	:	330-494-3423

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	08/22/2020

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