Healthcare Provider Details

I. General information

NPI: 1619211646
Provider Name (Legal Business Name): DAVID E CHILDS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 CHERRY AVE
ALLIANCE OH
44601-5022
US

IV. Provider business mailing address

360 WABASH AVE N
BREWSTER OH
44613-1042
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-3939
  • Fax: 330-829-9734
Mailing address:
  • Phone: 330-767-3451
  • Fax: 330-767-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: