Healthcare Provider Details

I. General information

NPI: 1568539708
Provider Name (Legal Business Name): SIFFRIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3688 DRESSLER RD NW
CANTON OH
44718-2781
US

IV. Provider business mailing address

3688 DRESSLER RD NW
CANTON OH
44718-2781
US

V. Phone/Fax

Practice location:
  • Phone: 330-478-0263
  • Fax: 330-478-0140
Mailing address:
  • Phone: 330-478-0263
  • Fax: 330-478-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRADLEY L VINCENT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 330-478-0263