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General NPI Number Information
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NPI Number | 1033303987
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Entity Type | Organization
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Legal Business Name | AVENUE TO INDEPENDENCE LLC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 1021 ROSLYN AVE SW
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City | CANTON
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State | OH
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Zip | 44710-1907
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Country | US
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Telephone | 330-454-8719
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 ROSLYN AVE SW
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City | CANTON
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State | OH
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Zip | 44710-1907
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Country | US
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Telephone | 330-454-8719
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. DAVID MARTIN MIDAY
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Credential |
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Telephone | 330-933-2316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 7603856
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 7603856
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License Number State | OH
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