MEDICARE: JESSICA A DAVIS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1881477917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA A DAVIS

Provider Business Mailing Address
First Line	:	1260 HOMEWOOD AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2155
Country	:	US
Telephone Number	:	330-244-7610
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 HOMEWOOD AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2155
Country	:	US
Telephone Number	:	330-244-7610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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Directions to “ JESSICA A DAVIS ” Practice Location

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