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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHELLE CARBO (OWNER/DOO)
(330) 519-8111
Entity
Organization

Contact information

Practice address
694 YANKEE RUN RD, MASURY, OH 44438-9760
(330) 519-8111
Mailing address
694 YANKEE RUN RD, MASURY, OH 44438-9760
(330) 519-8111

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
251X00000X
Supports Brokerage Agency
253Z00000X
In Home Supportive Care Agency
Primary
261QA0600X
Adult Day Care Clinic/Center
343900000X
Non-emergency Medical Transport (VAN)
347C00000X
Private Vehicle
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care

Other

Enumeration date
08/28/2023
Last updated
08/28/2023
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