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Organization

PROVIDER SERVICES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SUSAN B COSS MD (OWNER)
(330) 605-4541
Entity
Organization

Contact information

Practice address
3071 DUNBARTON AVE NW, CANTON, OH 44708-1818
(330) 605-4541
Mailing address
3071 DUNBARTON AVE NW, CANTON, OH 44708-1818
(330) 605-4541

Taxonomy

Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary

Other

Enumeration date
01/08/2018
Last updated
01/08/2018
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