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General NPI Number Information
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NPI Number | 1184426181
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Entity Type | Organization
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Legal Business Name | 1ST PLACE HOME AND DAY SERVICES
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 429 4TH ST NW
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City | CANTON
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State | OH
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Zip | 44702-1819
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Country | US
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Telephone | 234-214-2733
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Fax | --
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Provider Business Mailing Address
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Address Line | 1509 BAYCREST DR NW
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City | CANTON
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State | OH
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Zip | 44708-3083
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Country | US
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Telephone | 234-214-2733
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KEITH L SPIVA I
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Credential | BA, CESP
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Telephone | 234-214-2733
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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 |
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License Number State |
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