Healthcare Provider Details

I. General information

NPI: 1760759542
Provider Name (Legal Business Name): EVERETT GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7964 NORRITON CIR NW
NORTH CANTON OH
44720-5690
US

IV. Provider business mailing address

7964 NORRITON CIR NW
NORTH CANTON OH
44720-5690
US

V. Phone/Fax

Practice location:
  • Phone: 330-412-2202
  • Fax:
Mailing address:
  • Phone:
  • 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

VIII. Authorized Official

Name: MRS. TERESA E EVERETT
Title or Position: OWNER
Credential:
Phone: 330-412-2202