Healthcare Provider Details

I. General information

NPI: 1366712465
Provider Name (Legal Business Name): PROVIDING EXCELLENT ADULT KARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 WALES AVE NW SUITE 222
MASSILLON OH
44646-2310
US

IV. Provider business mailing address

2520 WALES AVE NW SUITE 222
MASSILLON OH
44646-2310
US

V. Phone/Fax

Practice location:
  • Phone: 330-833-7020
  • Fax: 866-999-3588
Mailing address:
  • Phone: 330-833-7020
  • Fax: 866-999-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. GREGG ALLEN ELLIOTT
Title or Position: CFO/ OWNER
Credential:
Phone: 330-833-7020