Provider Demographics
NPI:1316302813
Name:BWS DEVELOPMENTAL CARE CENTER LLC
Entity type:Organization
Organization Name:BWS DEVELOPMENTAL CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-608-1939
Mailing Address - Street 1:800 MARKET AVE N
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 MARKET AVE N
Practice Address - Street 2:SUITE #100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1083
Practice Address - Country:US
Practice Address - Phone:330-754-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2025-02-18
Deactivation Date:2024-06-07
Deactivation Code:
Reactivation Date:2025-02-18
Provider Licenses
StateLicense IDTaxonomies
OH0146342251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services