SHANNON LACKEY (NPI# 1639610561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639610561 |
| Entity Type | Individual |
| Full Name | SHANNON LACKEY |
| Practice Address |
746 Marion Ave Sw Canton OH 44707-4371 |
| Practice Telephone | 3303130919 |
| Mailing Telephone | 3303130919 |
| Enumeration Date | 2017-03-11 |
| Last Update Date | 2017-03-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251C00000X | Day Training, Developmentally Disabled Services | 3018853 | OH | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2551877 | 05 |
| Street Address |
746 MARION AVE SW |
| City | CANTON |
| State | OH |
| Zip Code | 44707-4371 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649781717 | Linda Wilt | Licensed Practical Nurse | 620market Ave. S., Canton, OH 44707 | 2017-10-17 |
| 1558872622 | Michele Rose Strongoli-scott | Registered Nurse | 1620 Market Ave S., Canton, OH 44707 | 2017-10-17 |
| 1366972234 | Terri Sue Clendenin | Home Health Aide | 1317 Mattie St Sw, Canton, OH 44707 | 2017-06-14 |
| 1215467311 | Draya K Ellis | Community Health Worker | 408 9th Street Sw, Canton, OH 44707 | 2017-06-13 |
| 1720537780 | Individual | Preferred Provider Organization | 1111 Gonder Avenue Se, Canton, OH 44707 | 2016-09-30 |
| 1962958512 | Individual | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gonder Av Se, Canton, OH 44707 | 2016-09-01 |
| 1184070526 | Mj Harvey Development, LLC | Day Training, Developmentally Disabled Services | 804 Marion Ave Sw, Canton, OH 44707 | 2016-05-04 |
| 1164898516 | Erica Marie Brown | Occupational Therapy Assistant | 1620 Market Ave., South, Canton, OH 44707 | 2015-08-19 |
| 1508256439 | Kenny Mcclelland | Military/U.S. Coast Guard Transport | 903 Alan Page Dr Se # Apt1, Canton, OH 44707 | 2015-01-30 |
| 1295143550 | Susan Elaine Ball | Technician | 908 6th St Sw, Canton, OH 44707 | 2014-07-30 |
| Find all providers in zip 44707 | ||||
| Taxonomy Code | 251C00000X |
| Grouping | Agencies |
| Classification | Day Training, Developmentally Disabled Services |
| These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558977363 | Northeast Developmental Services, Incorporated | Day Training, Developmentally Disabled Services | 7790 Market Ave N, Canton, OH 44721-1641 | 2020-09-17 |
| 1902428758 | Life Simplified, LLC | Day Training, Developmentally Disabled Services | 1104 48th St Nw, Canton, OH 44709-1210 | 2020-05-15 |
| 1629542741 | Tanzeah S Sharpe | Day Training, Developmentally Disabled Services | 137 Walnut Ave Ne Ste 213, Canton, OH 44702-1248 | 2019-01-11 |
| 1518437243 | Asd Smart Kids | Day Training, Developmentally Disabled Services | 337 Sylvan Drive, Canton, MI 48188-4818 | 2018-11-26 |
| 1306381199 | Genuine Loving Care LLC | Day Training, Developmentally Disabled Services | 2130 8th St Ne, Canton, OH 44704-2218 | 2017-01-03 |
| 1184070526 | Mj Harvey Development, LLC | Day Training, Developmentally Disabled Services | 804 Marion Ave Sw, Canton, OH 44707 | 2016-05-04 |
| 1851760631 | 1st Choice Providers LLC | Day Training, Developmentally Disabled Services | 3717 Fulton Dr Nw, Canton, OH 44718-3258 | 2015-09-22 |
| 1659782506 | Different Abilities Transportation and Care | Day Training, Developmentally Disabled Services | 1612 Tuscarawas St W, Canton, OH 44708-4847 | 2014-05-14 |
| 1447672928 | Peak Health Inc | Day Training, Developmentally Disabled Services | 4645 Monica Ave Sw, Canton, OH 44706-4525 | 2014-01-17 |
| 1144587767 | Advocacy 4 Independence LLC | Day Training, Developmentally Disabled Services | 916 Highland Rd Ne, Canton, OH 44704-1335 | 2012-04-19 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.