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General NPI Number Information
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NPI Number | 1316302813
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Entity Type | Organization
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Legal Business Name | BWS DEVELOPMENTAL CARE CENTER LLC
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 800 MARKET AVE N SUITE #100
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City | CANTON
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State | OH
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Zip | 44702-1083
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Country | US
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Telephone | 330-754-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 800 MARKET AVE N SUITE #100
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City | CANTON
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State | OH
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Zip | 44702-1083
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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 | MIKE BUSH
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Credential |
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Telephone | 330-608-1939
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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 | 0146342
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License Number State | OH
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