MEDICARE: CANTON FRIENDSHIP CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency		OH

General Provider Information

NPI Number	:	1376658344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTON FRIENDSHIP CENTER, INC.

Provider Business Mailing Address
First Line	:	2200 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3609
Country	:	US
Telephone Number	:	330-453-8768
Fax Number	:	330-454-4744

Provider Business Practice Location Address
First Line	:	2200 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3609
Country	:	US
Telephone Number	:	330-453-8768
Fax Number	:	330-454-4744

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. LYNN M MARKLEY
Credential	:	MBA
Telephone Number	:	330-453-8768

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/21/2022

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