Healthcare Provider Details

I. General information

NPI: 1992506679
Provider Name (Legal Business Name): JKP RESIDENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 CLEVELAND AVE NW
NORTH CANTON OH
44720-5659
US

IV. Provider business mailing address

7975 CLEVELAND AVE NW
NORTH CANTON OH
44720-5659
US

V. Phone/Fax

Practice location:
  • Phone: 330-754-5486
  • Fax:
Mailing address:
  • Phone: 330-754-5486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: KATIE FISCHER
Title or Position: CEO
Credential: BA
Phone: 330-754-5486