Healthcare Provider Details

I. General information

NPI: 1912641481
Provider Name (Legal Business Name): STARK RECOVERY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 WHIPPLE AVE NW STE 1
CANTON OH
44718-4802
US

IV. Provider business mailing address

3801 WHIPPLE AVE NW STE 1
CANTON OH
44718-4802
US

V. Phone/Fax

Practice location:
  • Phone: 216-413-0413
  • Fax: 888-509-7989
Mailing address:
  • Phone: 216-413-0413
  • Fax: 888-509-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLA HART-TYNER
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP-C
Phone: 216-413-0413