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General NPI Number Information
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NPI Number | 1972594802
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Entity Type | Organization
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Legal Business Name | NORTHEAST PROFESSIONAL HOME, INC.
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 4580 STEPHEN CIR NW STE 302
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City | CANTON
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State | OH
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Zip | 44718-3646
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Country | US
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Telephone | 330-966-2311
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Fax | 330-966-6893
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Provider Business Mailing Address
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Address Line | 4580 STEPHEN CIR NW STE 302
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City | CANTON
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State | OH
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Zip | 44718-3646
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Country | US
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Telephone | 330-966-2311
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Fax | 330-966-6893
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DALE W WELLS
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Credential | MBA, CHCE
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Telephone | 330-966-2311
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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 |
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License Number State |
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