Healthcare Provider Details

I. General information

NPI: 1164593455
Provider Name (Legal Business Name): COMMUNITY WELLNESS CENTER OF STARK COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CLEVELAND AVE NW
CANTON OH
44709-3602
US

IV. Provider business mailing address

1800 CLEVELAND AVE NW
CANTON OH
44709-3602
US

V. Phone/Fax

Practice location:
  • Phone: 330-456-7792
  • Fax: 330-456-7061
Mailing address:
  • Phone: 330-456-7792
  • Fax: 330-456-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLI J SCOTT
Title or Position: CEO EXECUTIVE DIRECTOR
Credential: MS
Phone: 330-456-7792