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General NPI Number Information
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NPI Number | 1184070526
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Entity Type | Organization
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Legal Business Name | MJ HARVEY DEVELOPMENT, LLC
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 804 MARION AVE SW
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City | CANTON
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State | OH
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Zip | 44707
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Country | US
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Telephone | 330-437-6838
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Fax |
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Provider Business Mailing Address
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Address Line | 4647 RENWORTH AVE NE
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City | CANTON
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State | OH
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Zip | 44714-1194
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MARLO J HARVEY
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Credential | LMSW, COTA/L
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Telephone | 330-437-6838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | M7605514
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License Number State | OH
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