Healthcare Provider Details

I. General information

NPI: 1730885419
Provider Name (Legal Business Name): JAZMONE DAVISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 DRESSLER RD NW STE 201B
CANTON OH
44718-2772
US

IV. Provider business mailing address

PO BOX 35521
CANTON OH
44735-5521
US

V. Phone/Fax

Practice location:
  • Phone: 330-284-2856
  • Fax: 330-830-6534
Mailing address:
  • Phone:
  • Fax: 216-412-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number374943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: