Healthcare Provider Details

I. General information

NPI: 1427352780
Provider Name (Legal Business Name): ASSET BUILDING & LIFE SKILLS ENVIRONMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 12TH ST NW
CANTON OH
44703-1944
US

IV. Provider business mailing address

1000 12TH ST NW
CANTON OH
44703-1944
US

V. Phone/Fax

Practice location:
  • Phone: 330-430-9380
  • Fax:
Mailing address:
  • Phone: 330-430-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7602580
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number7602580
License Number StateOH

VIII. Authorized Official

Name: MS. BARBARA J CURRENCE
Title or Position: CEO
Credential:
Phone: 330-430-9380