Provider Demographics
NPI:1356047732
Name:MEANS, BRANDEN DAVON
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:DAVON
Last Name:MEANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 GEORGETOWN RD NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-2375
Mailing Address - Country:US
Mailing Address - Phone:330-244-7105
Mailing Address - Fax:
Practice Address - Street 1:2449 GEORGETOWN RD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-2375
Practice Address - Country:US
Practice Address - Phone:330-244-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 374U00000X
37600000X376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000310820Medicaid