Provider Demographics
NPI:1912100744
Name:MEALS ON WHEELS OF STARK & WAYNE COUNTIES
Entity Type:Organization
Organization Name:MEALS ON WHEELS OF STARK & WAYNE COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-832-7220
Mailing Address - Street 1:2363 NAVE STREET SE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8822
Mailing Address - Country:US
Mailing Address - Phone:330-832-7220
Mailing Address - Fax:330-832-7425
Practice Address - Street 1:2363 NAVE STREET SE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8822
Practice Address - Country:US
Practice Address - Phone:330-832-7220
Practice Address - Fax:330-832-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2247821Medicaid
OH0808353Medicaid