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General NPI Number Information
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NPI Number | 1487339743
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Entity Type | Organization
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Legal Business Name | STARK COUNTY URBAN MINORITY ALCOHOL AND DRUG ADDICTION OUTREACH PROJE
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 1492 CHERRY AVE SE
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City | CANTON
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State | OH
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Zip | 44707-3474
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Country | US
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Telephone | 330-949-1927
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Fax |
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Provider Business Mailing Address
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Address Line | 1492 CHERRY AVE SE
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City | CANTON
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State | OH
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Zip | 44707-3474
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Country | US
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Telephone | 330-949-1927
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | IDA FREEMAN
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Credential |
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Telephone | 330-949-1927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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