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General NPI Number Information
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NPI Number | 1861095119
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Entity Type | Organization
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Legal Business Name | PIKE ADULT ACTIVITIES DBA CANAL INDUSTRIES
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 301 CLOUGH ST
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City | WAVERLY
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State | OH
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Zip | 45690-1112
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Country | US
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Telephone | 740-947-7502
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Fax | 740-947-2550
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Provider Business Mailing Address
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Address Line | 301 CLOUGH ST
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City | WAVERLY
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State | OH
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Zip | 45690-1112
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Country | US
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Telephone | 740-947-7502
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Fax | 740-947-2550
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | BECKY STEVENS
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Credential |
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Telephone | 740-947-7502
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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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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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