Organization
AVENUE TO INDEPENDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID MARTIN MIDAY (C.E.O.)
(330) 933-2316
Entity
Organization
Contact information
Practice address
1021 ROSLYN AVE SW, CANTON, OH 44710-1907
(330) 454-8719
Mailing address
1021 ROSLYN AVE SW, CANTON, OH 44710-1907
(330) 454-8719
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
7603856
OH
343900000X
Non-emergency Medical Transport (VAN)
7603856
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2724770
—
OH
Enumeration date
09/04/2007
Last updated
09/04/2007
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