Healthcare Provider Details

I. General information

NPI: 1013503952
Provider Name (Legal Business Name): ADULT DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 WHIPPLE AVE NW
CANTON OH
44708-2841
US

IV. Provider business mailing address

1944 WHIPPLE AVE NW
CANTON OH
44708-2841
US

V. Phone/Fax

Practice location:
  • Phone: 330-327-1696
  • Fax:
Mailing address:
  • Phone: 330-327-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD T MARTIN
Title or Position: CEO
Credential:
Phone: 330-327-1696