Healthcare Provider Details

I. General information

NPI: 1932573540
Provider Name (Legal Business Name): NEXT TO KIN SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 DIAGONAL RD
AKRON OH
44320-3751
US

IV. Provider business mailing address

1049 DIAGONAL RD
AKRON OH
44320-3751
US

V. Phone/Fax

Practice location:
  • Phone: 330-510-7847
  • Fax:
Mailing address:
  • Phone: 330-510-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number7714003
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number7714003
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number7714003
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number7714003
License Number StateOH

VIII. Authorized Official

Name: MISS LUCSHUNDA SAPRINA BLACKWELL
Title or Position: CEO
Credential:
Phone: 330-510-7847