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General NPI Number Information
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NPI Number | 1962619379
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Entity Type | Organization
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Legal Business Name | LARRY MCKINSTRY SERVICES LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 329 ARLINGTON AVE NW # 44708 1205 32ND STREET NE (GROUP HOME) 44714
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City | CANTON
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State | OH
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Zip | 44708-4703
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Country | US
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Telephone | 330-575-1861
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Fax | 330-452-1296
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Provider Business Mailing Address
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Address Line | 329 ARLINGTON AVE NW # 44708 1205 32ND STREET NE (GROUP HOME) 44714
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City | CANTON
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State | OH
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Zip | 44708-4703
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Country | US
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Telephone | 330-575-1861
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Fax | 330-452-1296
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR
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Name | MR. LARRY L. MCKINSTRY
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Credential | BA, QMRP
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Telephone | 330-575-1861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 7600760
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License Number State | OH
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