Provider Demographics
NPI:1194396689
Name:STARK RECOVERY ASSOCIATES
Entity Type:Organization
Organization Name:STARK RECOVERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HART-TYNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:216-413-0413
Mailing Address - Street 1:3801 WHIPPLE AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4802
Mailing Address - Country:US
Mailing Address - Phone:216-413-0413
Mailing Address - Fax:
Practice Address - Street 1:3801 WHIPPLE AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4802
Practice Address - Country:US
Practice Address - Phone:216-413-0413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center