Healthcare Provider Details

I. General information

NPI: 1497849848
Provider Name (Legal Business Name): NETSOURCE HEALTH SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 7TH ST NW
CANTON OH
44708-4315
US

IV. Provider business mailing address

2812 7TH ST NW
CANTON OH
44708-4315
US

V. Phone/Fax

Practice location:
  • Phone: 330-412-4327
  • Fax:
Mailing address:
  • Phone: 330-412-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberCOA.05016-NP
License Number StateOH

VIII. Authorized Official

Name: SHIRLEY I. D. MCINTOSH
Title or Position: AGENT
Credential: N.P.
Phone: 330-412-4327