Healthcare Provider Details

I. General information

NPI: 1881965598
Provider Name (Legal Business Name): SHIPLEY HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 WHIPPLE AVE NW
CANTON OH
44708-2836
US

IV. Provider business mailing address

1715 WHIPPLE AVE NW
CANTON OH
44708-2836
US

V. Phone/Fax

Practice location:
  • Phone: 330-232-1007
  • Fax:
Mailing address:
  • Phone: 330-232-1007
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number7606460
License Number StateOH

VIII. Authorized Official

Name: MR. JEFFREY J SHIPLEY
Title or Position: CEO
Credential:
Phone: 330-232-1007