Provider Demographics
| NPI: | 1720828593 |
|---|---|
| Name: | BUCKEYE FAMILY SERVICE LLC |
| Entity type: | Organization |
| Organization Name: | BUCKEYE FAMILY SERVICE LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SHANITA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JONES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 234-804-4060 |
| Mailing Address - Street 1: | 2415 20TH ST NE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CANTON |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 44705-2405 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 234-804-4060 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2415 20TH ST NE |
| Practice Address - Street 2: | |
| Practice Address - City: | CANTON |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 44705-2405 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 234-804-4060 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-05-29 |
| Last Update Date: | 2024-05-29 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 174200000X | Other Service Providers | Meals | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 332900000X | Suppliers | Non-Pharmacy Dispensing Site | |
| No | 332U00000X | Suppliers | Home Delivered Meals | |
| No | 343800000X | Transportation Services | Secured Medical Transport (VAN) | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
