Healthcare Provider Details

I. General information

NPI: 1457025702
Provider Name (Legal Business Name): MRS. JEAN CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 VALENTINE FARMS DR
AKRON OH
44333-2285
US

IV. Provider business mailing address

229 VALENTINE FARMS DR
AKRON OH
44333-2285
US

V. Phone/Fax

Practice location:
  • Phone: 440-620-3050
  • Fax:
Mailing address:
  • Phone: 440-620-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: