Provider Demographics
NPI:1275300709
Name:MITCHELL, RICHARD THOMAS
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7116
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-0116
Mailing Address - Country:US
Mailing Address - Phone:330-313-4513
Mailing Address - Fax:
Practice Address - Street 1:4434 WOODLAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1354
Practice Address - Country:US
Practice Address - Phone:330-313-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant