Provider Demographics
NPI:1689379620
Name:STACK, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:STACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1502
Mailing Address - Country:US
Mailing Address - Phone:330-715-0165
Mailing Address - Fax:
Practice Address - Street 1:167 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1502
Practice Address - Country:US
Practice Address - Phone:330-715-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle