Healthcare Provider Details

I. General information

NPI: 1174451058
Provider Name (Legal Business Name): COUP DE MAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 PLAIN AVE NE
CANTON OH
44714-2346
US

IV. Provider business mailing address

1624 PLAIN AVE NE
CANTON OH
44714-2346
US

V. Phone/Fax

Practice location:
  • Phone: 330-224-7560
  • Fax:
Mailing address:
  • Phone: 330-224-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: WANDA JO MCCOLLUM-DOTSON
Title or Position: DIRECTOR OF OPERATION
Credential:
Phone: 330-224-7560