Healthcare Provider Details

I. General information

NPI: 1316302813
Provider Name (Legal Business Name): BWS DEVELOPMENTAL CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 02/18/2025
Certification Date: 12/17/2020
Deactivation Date: 06/07/2024
Reactivation Date: 02/18/2025

III. Provider practice location address

800 MARKET AVE N SUITE #100
CANTON OH
44702-1083
US

IV. Provider business mailing address

800 MARKET AVE N SUITE #100
CANTON OH
44702-1083
US

V. Phone/Fax

Practice location:
  • Phone: 330-754-6811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0146342
License Number StateOH

VIII. Authorized Official

Name: MIKE BUSH
Title or Position: CEO
Credential:
Phone: 330-608-1939