Healthcare Provider Details

I. General information

NPI: 1184334542
Provider Name (Legal Business Name): PRIDE & JOY SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 CASTLEBAR ST NW
CANTON OH
44708-2045
US

IV. Provider business mailing address

4805 CASTLEBAR ST NW
CANTON OH
44708-2045
US

V. Phone/Fax

Practice location:
  • Phone: 330-430-9662
  • Fax:
Mailing address:
  • Phone: 330-430-9662
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL MCLENDON
Title or Position: OWNER
Credential:
Phone: 330-430-9662