Healthcare Provider Details

I. General information

NPI: 1477962975
Provider Name (Legal Business Name): J. R. COLEMAN SENIOR OUTREACH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PARKWAY ST NW
CANTON OH
44708-3832
US

IV. Provider business mailing address

1731 GRACE AVE NE
CANTON OH
44705-2261
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-3471
  • Fax: 330-454-6371
Mailing address:
  • Phone: 330-455-3873
  • Fax: 330-455-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TOM THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 330-455-3873