Healthcare Provider Details

I. General information

NPI: 1922641802
Provider Name (Legal Business Name): GABLES CANTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 GREENTREE AVE SW
CANTON OH
44706-4024
US

IV. Provider business mailing address

3660 GREENTREE AVE SW
CANTON OH
44706-4024
US

V. Phone/Fax

Practice location:
  • Phone: 330-209-2128
  • Fax:
Mailing address:
  • Phone: 330-209-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISSY MARIE MASSARO
Title or Position: EXECUTIVE DIRECTOR
Credential: C.E.A.L.
Phone: 330-209-2128