Healthcare Provider Details

I. General information

NPI: 1144587767
Provider Name (Legal Business Name): ADVOCACY 4 INDEPENDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 HIGHLAND RD NE
CANTON OH
44704-1335
US

IV. Provider business mailing address

916 HIGHLAND RD NE
CANTON OH
44704-1335
US

V. Phone/Fax

Practice location:
  • Phone: 330-244-7190
  • Fax:
Mailing address:
  • Phone: 330-244-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberRL541069
License Number StateOH

VIII. Authorized Official

Name: MS. MICHELE JEAN ANDREWS
Title or Position: CEO
Credential:
Phone: 330-244-7190