Provider Demographics
NPI:1962619379
Name:LARRY MCKINSTRY SERVICES LLC
Entity type:Organization
Organization Name:LARRY MCKINSTRY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKINSTRY
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QMRP
Authorized Official - Phone:330-575-1861
Mailing Address - Street 1:329 ARLINGTON AVE NW # 44708
Mailing Address - Street 2:1205 32ND STREET NE (GROUP HOME) 44714
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4703
Mailing Address - Country:US
Mailing Address - Phone:330-575-1861
Mailing Address - Fax:330-452-1296
Practice Address - Street 1:329 ARLINGTON AVE NW # 44708
Practice Address - Street 2:1205 32ND STREET NE (GROUP HOME) 44714
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4703
Practice Address - Country:US
Practice Address - Phone:330-575-1861
Practice Address - Fax:330-452-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7600760251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health