Healthcare Provider Details

I. General information

NPI: 1922694850
Provider Name (Legal Business Name): WHOLE LATTE LOVE CAFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S MAIN ST
NORTH CANTON OH
44720-4244
US

IV. Provider business mailing address

503 EASTBURY AVE NE
NORTH CANTON OH
44720-2136
US

V. Phone/Fax

Practice location:
  • Phone: 330-323-8401
  • Fax:
Mailing address:
  • Phone: 330-323-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETH A HUMBERT
Title or Position: FOUNDER / EXECUTIVE DIRECTOR
Credential: CRC, CESP
Phone: 330-323-8401