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General NPI Number Information
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NPI Number | 1538762281
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Entity Type | Organization
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Legal Business Name | CHEROKEE ROSE RESIDENTIAL LLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 15292 SALEM ALLIANCE RD
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City | SALEM
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State | OH
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Zip | 44460-7616
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Country | US
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Telephone | 330-261-2191
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Fax | 330-446-4089
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Provider Business Mailing Address
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Address Line | PO BOX 583
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City | SALEM
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State | OH
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Zip | 44460-0583
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Country | US
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Telephone | 330-507-8411
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Fax | 330-446-4089
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CANDICE JONES
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Credential |
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Telephone | 133-050-7841
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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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