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NPI Code Detail

MEDICARE: OHIO COLLEGIATE ACADEMY

MEDICARE: OHIO COLLEGIATE ACADEMY
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
1251300000XLocal Education Agency (LEA)

General Provider Information

NPI Number : 1790111870
Entity Type Code : Organization
Provider Name (Legal Business Name) : OHIO COLLEGIATE ACADEMY
Provider Business Mailing Address
First Line : 219 E MAPLE ST
Second Line : SUITE #202
City : NORTH CANTON
State : OH
Zip : 44720-2586
Country : US
Telephone Number : 330-515-0572
Fax Number : 330-409-0270
Provider Business Practice Location Address
First Line : 21100 SOUTHGATE PARK BLVD
Second Line :
City : MAPLE HEIGHTS
State : OH
Zip : 44137-3004
Country : US
Telephone Number : 330-515-0572
Fax Number : 330-409-0270
Authorized Official
Title or Position : CHIEF FIANCIAL OFFICER
Name : MR. C. DAVID MASSA
Credential : CPA
Telephone Number : 330-515-0572
Provider Enumeration Date : 09/19/2013
Last Update Date : 09/19/2013

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Directions to “OHIO COLLEGIATE ACADEMY ” Practice Location

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