| Stark Recovery Associates, Llc | |
|
3801 Whipple Ave Nw Ste 1 Canton OH 44718-4802 | |
| (216) 413-0413 | |
| (888) 509-7989 |
| Full Name | Stark Recovery Associates, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3801 Whipple Ave Nw Ste 1, Canton, Ohio |
| Authorized Official Name and Position | Carla Hart-tyner (NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 2164130413 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stark Recovery Associates, Llc 3801 Whipple Ave Nw Ste 1 Canton OH 44718-4802 Ph: (216) 413-0413 | Stark Recovery Associates, Llc 3801 Whipple Ave Nw Ste 1 Canton OH 44718-4802 Ph: (216) 413-0413 |
| NPI Number | 1912641481 |
|---|---|
| Provider Enumeration Date | 04/21/2022 |
| Last Update Date | 02/20/2023 |
| Certification Date | 02/20/2023 |
| Medicare PECOS PAC ID | 6002272309 |
|---|---|
| Medicare Enrollment ID | O20230511000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912641481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
| Provider Name | Anne Wise |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568429884 PECOS PAC ID: 1254380744 Enrollment ID: I20050121000860 |
| Provider Name | Jean M Knudsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992032460 PECOS PAC ID: 2365581451 Enrollment ID: I20091203000001 |
| Provider Name | Carla V Hart-tyner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134476088 PECOS PAC ID: 8224280938 Enrollment ID: I20121204000076 |
| Provider Name | Mohammed F Ahmad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033472386 PECOS PAC ID: 6204141021 Enrollment ID: I20150821014274 |
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