Individual
JARVIS MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2105 ASHLAND ST APT B, LOUISVILLE, OH 44641-9032
(330) 356-2510
Mailing address
2105 ASHLAND ST APT B, LOUISVILLE, OH 44641-9032
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
04/17/2020
Last updated
11/06/2023
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