1083828305 NPI number — MASSILLON HEALTH DEPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083828305 NPI number — MASSILLON HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSILLON HEALTH DEPT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083828305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 TREMONT AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSILLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44647-6571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-830-1713
Provider Business Mailing Address Fax Number:
330-830-2852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 ERIE ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSILLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44646-6711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-830-1713
Provider Business Practice Location Address Fax Number:
330-830-2852
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SYLVESTER
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
330-830-1713

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: RN260840 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0873407 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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