Healthcare Provider Details

I. General information

NPI: 1184615148
Provider Name (Legal Business Name): NORTHEAST PROFESSIONAL HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 STEPHEN CIR NW STE 301
CANTON OH
44718-3646
US

IV. Provider business mailing address

4580 STEPHEN CIR NW STE 301
CANTON OH
44718-3646
US

V. Phone/Fax

Practice location:
  • Phone: 330-966-2311
  • Fax: 330-966-2381
Mailing address:
  • Phone: 330-966-2311
  • Fax: 330-966-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DALE W WELLS
Title or Position: CEO
Credential:
Phone: 330-966-2311