INDIVIDUAL (NPI# 1962958512) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962958512 |
| Entity Type | Organization |
| Organization Name | INDIVIDUAL |
| Practice Address |
1111 Gonder Av Se Canton OH 44707 |
| Practice Telephone | 3302657902 |
| Mailing Telephone | 3302657902 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |
| Authorized Official Name | MISS TAMMIE LYNN MAYLE (HOME HEALTH AID) |
| Authorized Official Telephone | 3302657902 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720537780 | Individual | Preferred Provider Organization | 1111 Gonder Avenue Se, Canton, OH 44707 | 2016-09-30 |
| 1356793509 | Individual | Clinic/Center | 3500 Timberwood Cir Apt 2137, Arlington, TX 76015-3129 | 2016-07-11 |
| 1669862587 | Individual | Specialist/Technologist | 2926 Waldon Park Dr, Orion, MI 48359-1336 | 2015-01-30 |
| 1780092817 | Individual | Skilled Nursing Facility | 5311 Albany Cir, Tobaccoville, NC 27050-9723 | 2014-08-01 |
| 1316361496 | Individual | Community/Behavioral Health | 2484 Ga Highway 100, Hogansville, GA 30230-3719 | 2014-02-11 |
| 1134534563 | Individual | Public Health or Welfare | 81 Plantation Street, Worcester, MA 01604 | 2014-06-24 |
| 1881019123 | Individual | Community/Behavioral Health | 12966 Euclid St, Suite 280, Garden Grove, CA 92840-5200 | 2014-02-24 |
| 1952724932 | Individual | Nursing Care | 1019 Westside Dr, Cuba, MO 65453-1025 | 2014-01-28 |
| 1639415920 | Individual | Residential Treatment Facility, Emotionally Disturbed Children | 1725 Shivers Rd, Columbia, SC 29210-5413 | 2012-12-14 |
| 1558663963 | Individual | Clinic/Center | 8105 Hidden Quail Ave, Las Vegas, NV 89131-4647 | 2010-11-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | INDIVIDUAL | 200 E Pine St, Somonauk, IL 60552-9812 |
| Virginia Business Entities | Individual & Employee Wellness LLC | 244 Ridgeway Drive, Farmville, Virginia 23901 |
| Oregon Corporations, Companies and Business Names | INDIVIDUAL & FAMILY GROWTH CENTER-MICHOL POLSON PHD | 204 Riverside Dr, Klamath Falls, OR 97601 |
| Colorado Business Entities | Individual & Family Recovery Inc. | 420 21st Ave., Suite 115, Longmont, CO 80501 |
| Oklahoma Business Registrations | INDIVIDUAL & FAMILY SERVICE L.L.C. | 2840 E 52nd St Ste 105, Tulsa, OK 74105 |
| Massachusetts Corporations | INDIVIDUAL & FAMILY SUPPORT CENTERS, INC. | 81 Hope Avenue, Worcester, MA 02721 |
| Virginia Business Entities | INDIVIDUAL & GROUP HEALTH PLANS INC. | 6025 Lee Hwy Ste 415, Chattanooga, Tennessee 37421 |
| Colorado Business Entities | Individual 1 | 17900 E 56th Ave, Apt 113, Denver, CO 80249 |
| Colorado Business Entities | Individual Academic Development, LLC | Po Box 2109, Parker, CO 80134 |
| Colorado Business Entities | Individual Advantages Inc | 617 Church Road, Elgin, IL 60123 |
| Street Address |
1111 GONDER AV SE |
| City | CANTON |
| State | OH |
| Zip Code | 44707 |
| 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 |
| 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 |
| 1528488764 | Shala Lenee Brown | Registered Nurse | 401 14th St Se, Canton, OH 44707 | 2014-04-25 |
| Find all providers in zip 44707 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174177737 | Alive Now Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6717 Amsel Ave Ne, Canton, OH 44721-2606 | 2019-07-31 |
| 1083880603 | Quality Choice,llc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3074 Rusty Ave Sw, Canton, OH 44706-3329 | 2008-05-03 |
| 1699958025 | Judge Rotenberg Educational Center, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 240 Turnpike St, Canton, MA 02021-2359 | 2007-12-07 |
| 1912061797 | Living 4 Independence | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4629 Helmsworth Dr Ne, Canton, OH 44714-1162 | 2006-12-19 |
| 1174547780 | Andrews Center/ Short St | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 205 Short St, Canton, TX 75103-2609 | 2006-07-27 |
| 1396769907 | Andrews Center/ Millcreek | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1611 Mill Creek Rd, Canton, TX 75103-3114 | 2006-07-27 |
| 1467515577 | Care Focus, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4150 Belden Village St Nw, Suite 301, Canton, OH 44718-2595 | 2006-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467053801 | Vip of Ohio, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2446 Audubon Rd, Akron, OH 44320-1010 | 2020-11-03 |
| 1871190280 | Gateways To Better Living Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6000 Mahoning Ave Ste 234, Youngstown, OH 44515-2225 | 2020-10-08 |
| 1235746264 | Cheryl L Nelson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 21891 Ringgold Southern Rd, Circleville, OH 43113-9263 | 2020-09-24 |
| 1164039244 | Amberdawn E Kenworthy-byers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3746 Hickory Ln, Greenville, OH 45331-3014 | 2020-09-23 |
| 1467067124 | Forever Care LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5240 Northtowne Blvd Apt C, Columbus, OH 43229-4661 | 2020-09-10 |
| 1154846095 | Anitra L Richardson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3321 Hackberry St, Cincinnati, OH 45207-1701 | 2017-08-11 |
| 1811447519 | Royal Queens Care Agency | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6625 Retton Rd, Reynoldsburg, OH 43068-2849 | 2016-10-06 |
| 1700238391 | Rose-mary, The Johanna Grasselli Rehabilitation and Education Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4383 Ammon Rd, Cleveland, OH 44143-2803 | 2016-07-07 |
| 1619324290 | Rose-mary, The Johanna Grasselli Rehabilitation and Education Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 9349 W Ridgewood Dr, Parma Heights, OH 44130-4126 | 2016-05-24 |
| 1124472436 | Rose-mary The Johanna Grasselli Rehabilitation and Education Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 391 Cary Jay Blvd, Richmond Heights, OH 44143-1725 | 2016-04-22 |
| Find all providers with the same taxonomy | ||||
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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.