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NPI Code Detail

MEDICARE: AVERY FAITH MANSE

MEDICARE: AVERY FAITH MANSE
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
1171M00000XCase Manager/Care CoordinatorOH

General Provider Information

NPI Number : 1619815214
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY FAITH MANSE
Provider Business Mailing Address
First Line : 4843 UNION AVE NE
Second Line :
City : HOMEWORTH
State : OH
Zip : 44634-9637
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4641 FULTON DR NW
Second Line :
City : CANTON
State : OH
Zip : 44718-2384
Country : US
Telephone Number : 330-433-6075
Fax Number : 330-494-0299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2026
Last Update Date : 03/24/2026

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Directions to “ AVERY FAITH MANSE ” Practice Location

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