MEDICARE: JASON'S PLACE, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1871195792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON'S PLACE, INC.

Provider Business Mailing Address
First Line	:	7638 DIAMONDBACK AVE NW
Second Line	:
City	:	CANAL FULTON
State	:	OH
Zip	:	44614-8109
Country	:	US
Telephone Number	:	330-309-9344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 EASTON ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-2655
Country	:	US
Telephone Number	:	330-309-9344
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MELISSA E. HADNETT
Credential	:
Telephone Number	:	330-309-9344

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “JASON'S PLACE, INC. ” Practice Location

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