Provider Demographics
NPI:1164593455
Name:COMMUNITY WELLNESS CENTER OF STARK COUNTY, INC.
Entity Type:Organization
Organization Name:COMMUNITY WELLNESS CENTER OF STARK COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:330-456-7792
Mailing Address - Street 1:1800 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3602
Mailing Address - Country:US
Mailing Address - Phone:330-456-7792
Mailing Address - Fax:330-456-7061
Practice Address - Street 1:1800 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3602
Practice Address - Country:US
Practice Address - Phone:330-456-7792
Practice Address - Fax:330-456-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management