Healthcare Provider Details

I. General information

NPI: 1417785312
Provider Name (Legal Business Name): ADENA LENORE BEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 2ND ST NE
CANTON OH
44704-1132
US

IV. Provider business mailing address

3049 25TH ST NW # 304925TH
CANTON OH
44708-2435
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-7917
  • Fax:
Mailing address:
  • Phone: 330-312-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: