1316302813 NPI number — BWS DEVELOPMENTAL CARE CENTER LLC

Table of content: (NPI 1316302813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316302813 NPI number — BWS DEVELOPMENTAL CARE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BWS DEVELOPMENTAL CARE CENTER LLC
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:
1316302813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/07/2024
NPI Reactivation Date:
02/18/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 MARKET AVE N
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44702-1083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MARKET AVE N
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44702-1083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-754-6811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BUSH
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
330-608-1939

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  0146342 , 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)





Copyright © 2007-2025 www.npivalidator.com