Organization
COUP DE MAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA JO MCCOLLUM-DOTSON (DIRECTOR OF OPERATION)
(330) 224-7560
Entity
Organization
Contact information
Practice address
1624 PLAIN AVE NE, CANTON, OH 44714-2346
(330) 224-7560
Mailing address
1624 PLAIN AVE NE, CANTON, OH 44714-2346
(330) 224-7560
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
05/12/2026
Last updated
05/12/2026
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