Healthcare Provider Details

I. General information

NPI: 1558247924
Provider Name (Legal Business Name): TYFENN PEEPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PARK AVE SW
CANTON OH
44706-1228
US

IV. Provider business mailing address

817 PARK AVE SW
CANTON OH
44706-1228
US

V. Phone/Fax

Practice location:
  • Phone: 773-679-9641
  • Fax:
Mailing address:
  • Phone: 773-679-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACEY RICHARDSON
Title or Position: OWNER
Credential:
Phone: 773-679-9641