Healthcare Provider Details

I. General information

NPI: 1588115711
Provider Name (Legal Business Name): BLUE RIBBON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 APPLEGROVE ST NE APT A-7
CANTON OH
44720-8688
US

IV. Provider business mailing address

PO BOX 3093
AKRON OH
44309-3093
US

V. Phone/Fax

Practice location:
  • Phone: 216-315-4871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER WILLIAMS
Title or Position: OWNER
Credential:
Phone: 216-315-4871