Healthcare Provider Details

I. General information

NPI: 1639146574
Provider Name (Legal Business Name): NORTH CANTON PLAYHOUSE SPOTLIGHT ON YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 E MAPLE ST
NORTH CANTON OH
44720-2678
US

IV. Provider business mailing address

1127 E MAPLE ST
NORTH CANTON OH
44720-2678
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-3423
  • Fax:
Mailing address:
  • Phone: 330-494-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERA LYNN TRIPP
Title or Position: EXECUTIVE DIRECTOR
Credential: ED
Phone: 330-494-3423