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NPI Code Detail

MEDICARE: STARK COUNTY TASC

MEDICARE: STARK COUNTY TASC
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
1251B00000XCase Management Agency
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
108321OTHEROHMACSIS UPI

General Provider Information

NPI Number : 1720033806
Entity Type Code : Organization
Provider Name (Legal Business Name) : STARK COUNTY TASC
Provider Business Mailing Address
First Line : 624 MARKET AVE N
Second Line :
City : CANTON
State : OH
Zip : 44702-1017
Country : US
Telephone Number : 330-327-4826
Fax Number : 330-479-0977
Provider Business Practice Location Address
First Line : 624 MARKET AVE N
Second Line :
City : CANTON
State : OH
Zip : 44702-1017
Country : US
Telephone Number : 330-327-4826
Fax Number : 330-479-0977
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DAVID A. WILLS
Credential : MPA,LICDC
Telephone Number : 330-479-1912
Provider Enumeration Date : 05/24/2006
Last Update Date : 09/28/2020

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Directions to “STARK COUNTY TASC ” Practice Location

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