Healthcare Provider Details

I. General information

NPI: 1093379240
Provider Name (Legal Business Name): KAY MANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 N FOUR MILE RUN RD
YOUNGSTOWN OH
44515-1502
US

IV. Provider business mailing address

487 N FOUR MILE RUN RD
YOUNGSTOWN OH
44515-1502
US

V. Phone/Fax

Practice location:
  • Phone: 330-259-5469
  • Fax:
Mailing address:
  • Phone: 330-259-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: