Healthcare Provider Details

I. General information

NPI: 1619563210
Provider Name (Legal Business Name): BETTER LIFESTYLES RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 23RD ST NW
CANTON OH
44709-3917
US

IV. Provider business mailing address

127 23RD ST NW
CANTON OH
44709-3917
US

V. Phone/Fax

Practice location:
  • Phone: 330-418-8939
  • Fax: 330-956-5696
Mailing address:
  • Phone: 330-418-8939
  • Fax: 330-956-5696

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIE L EDMONDSON
Title or Position: CEO
Credential: MBA
Phone: 330-418-8939