Provider Demographics
NPI:1376063479
Name:1ST PLACE HOME AND DAY SERVICES
Entity Type:Organization
Organization Name:1ST PLACE HOME AND DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPIVA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:234-214-2733
Mailing Address - Street 1:1219 10TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-3369
Mailing Address - Country:US
Mailing Address - Phone:234-214-2733
Mailing Address - Fax:
Practice Address - Street 1:1219 10TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-3369
Practice Address - Country:US
Practice Address - Phone:234-214-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251E00000XAgenciesHome Health