Provider Demographics
NPI:1609846310
Name:CANTON COMMUNITY KIDSUMMIT AGAINST DRUGS
Entity Type:Organization
Organization Name:CANTON COMMUNITY KIDSUMMIT AGAINST DRUGS
Other - Org Name:KIDSUMMIT AGAINST DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:OCPS II
Authorized Official - Phone:330-453-1155
Mailing Address - Street 1:1227 GROSS AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-1605
Mailing Address - Country:US
Mailing Address - Phone:330-453-1155
Mailing Address - Fax:330-453-2156
Practice Address - Street 1:1227 GROSS AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-1605
Practice Address - Country:US
Practice Address - Phone:330-453-1155
Practice Address - Fax:330-453-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH785300251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02563Medicare UPIN