Healthcare Provider Details

I. General information

NPI: 1831492842
Provider Name (Legal Business Name): BEYOND OUR BOUNDARIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CLEVELAND AVE NW
CANTON OH
44702-1805
US

IV. Provider business mailing address

601 CLEVELAND AVE NW
CANTON OH
44702-1805
US

V. Phone/Fax

Practice location:
  • Phone: 330-455-8111
  • Fax: 330-479-9260
Mailing address:
  • Phone: 330-455-8111
  • Fax: 330-479-9260

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: MS. DEBRA K SHUMARD
Title or Position: DIRECTOR
Credential: CTRS
Phone: 330-309-0838