Provider Demographics
NPI: | 1831492842 |
---|---|
Name: | BEYOND OUR BOUNDARIES, LLC |
Entity Type: | Organization |
Organization Name: | BEYOND OUR BOUNDARIES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DEBRA |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | SHUMARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CTRS |
Authorized Official - Phone: | 330-309-0838 |
Mailing Address - Street 1: | 601 CLEVELAND AVE NW |
Mailing Address - Street 2: | |
Mailing Address - City: | CANTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44702-1805 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-455-8111 |
Mailing Address - Fax: | 330-479-9260 |
Practice Address - Street 1: | 601 CLEVELAND AVE NW |
Practice Address - Street 2: | |
Practice Address - City: | CANTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44702-1805 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-455-8111 |
Practice Address - Fax: | 330-479-9260 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-12-13 |
Last Update Date: | 2010-12-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 7602642 | Medicaid |