| Kicos Wellness Center, Inc. | |
|
2823 Aaronwood Ave Ne Ste A Massillon OH 44646-2371 | |
| (330) 880-4888 | |
| Not Available |
| Full Name | Kicos Wellness Center, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2823 Aaronwood Ave Ne Ste A, Massillon, Ohio |
| Authorized Official Name and Position | Char Lynn Kicos (PRESIDENT/CEO) |
| Authorized Official Contact | 3308804888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kicos Wellness Center, Inc. 2823 Aaronwood Ave Ne Ste A Massillon OH 44646-2371 Ph: (330) 880-4888 | Kicos Wellness Center, Inc. 2823 Aaronwood Ave Ne Ste A Massillon OH 44646-2371 Ph: (330) 880-4888 |
| NPI Number | 1093386732 |
|---|---|
| Provider Enumeration Date | 07/04/2021 |
| Last Update Date | 07/04/2021 |
| Certification Date | 07/04/2021 |
| Medicare PECOS PAC ID | 4587062237 |
|---|---|
| Medicare Enrollment ID | O20211011000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093386732 | NPI | - | NPPES |
| 0376111 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Neil Tournoux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285352880 PECOS PAC ID: 0244615862 Enrollment ID: I20220919001550 |
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