MEDICARE: CANTON COMMUNITY KIDSUMMIT AGAINST DRUGS

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	785300	OH

General Provider Information

NPI Number	:	1609846310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTON COMMUNITY KIDSUMMIT AGAINST DRUGS

Provider Business Mailing Address
First Line	:	1227 GROSS AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-1605
Country	:	US
Telephone Number	:	330-453-1155
Fax Number	:	330-453-2156

Provider Business Practice Location Address
First Line	:	1227 GROSS AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-1605
Country	:	US
Telephone Number	:	330-453-1155
Fax Number	:	330-453-2156

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOSEPH C PARIS
Credential	:	OCPS II
Telephone Number	:	330-453-1155

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/22/2020

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