Healthcare Provider Details

I. General information

NPI: 1679202667
Provider Name (Legal Business Name): QUALITY COMFORT LIVING & SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 WHIPPLE AVE NW STE C
CANTON OH
44718-4800
US

IV. Provider business mailing address

PO BOX 36302
CANTON OH
44735-6302
US

V. Phone/Fax

Practice location:
  • Phone: 330-280-7659
  • Fax:
Mailing address:
  • Phone: 330-280-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KAREEM DAVISON
Title or Position: PRESIDENT
Credential:
Phone: 330-280-7659