Healthcare Provider Details

I. General information

NPI: 1932638038
Provider Name (Legal Business Name): HALL OF FAME RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6691 FREEDOM AVE NW
CANTON OH
44720-7301
US

IV. Provider business mailing address

6691 FREEDOM AVE NW
CANTON OH
44720-7301
US

V. Phone/Fax

Practice location:
  • Phone: 234-714-9320
  • Fax:
Mailing address:
  • Phone: 234-714-9320
  • 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: MELISSA ANN WEBSTER
Title or Position: COO
Credential: RN
Phone: 234-714-9320