Healthcare Provider Details

I. General information

NPI: 1962949883
Provider Name (Legal Business Name): CHAUNTELLE ANDREWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 14TH ST SW
CANTON OH
44710
US

IV. Provider business mailing address

3210 14TH ST SW
CANTON OH
44710-2328
US

V. Phone/Fax

Practice location:
  • Phone: 330-313-6266
  • Fax:
Mailing address:
  • Phone: 330-313-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0185349
License Number StateOH

VIII. Authorized Official

Name: HAUNTELLE ANDREWS
Title or Position: INDEPENDENT PROVIDER
Credential:
Phone: 330-313-6266