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General NPI Number Information
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NPI Number | 1063399020
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Entity Type | Individual
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Provider Name | CHANCELOR BUSH
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Gender | Male
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 108 3RD ST NE
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City | MASSILLON
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State | OH
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Zip | 44646-5605
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Country | US
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Telephone | 330-224-4823
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Fax | 614-468-1246
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Provider Business Mailing Address
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Address Line | 1720 FREDERICK AVE SW
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City | CANTON
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State | OH
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Zip | 44706-5314
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Country | US
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Telephone | 330-224-4823
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Fax | 330-224-4823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 7611206
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License Number State | OH
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