Healthcare Provider Details

I. General information

NPI: 1164366944
Provider Name (Legal Business Name): MIKAYLAS MISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 E WATERLOO RD STE 104
AKRON OH
44312-3818
US

IV. Provider business mailing address

7801 PROUTY RD
LODI OH
44254-9614
US

V. Phone/Fax

Practice location:
  • Phone: 330-933-4795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA KAY COUGHENOUR
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 330-933-4795