Provider Demographics
NPI:1760568893
Name:EDWIN SHAW REHAB AGMC
Entity Type:Organization
Organization Name:EDWIN SHAW REHAB AGMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CHEMICAL DEPENDENCY SERV.
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYSZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-784-1271
Mailing Address - Street 1:2402 COPLEY RD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2104
Mailing Address - Country:US
Mailing Address - Phone:330-607-4585
Mailing Address - Fax:
Practice Address - Street 1:1621 FLICKINGER RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4402
Practice Address - Country:US
Practice Address - Phone:330-784-1271
Practice Address - Fax:330-784-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health