Basic Information
| Provider Information | |||||||||
| NPI: | 1184040529 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE VILLAGE NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DENNISON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446211114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304175810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3011 AKRON RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446917904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302643232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2014 | ||||||||
| LastUpdateDate: | 03/10/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TARBERT | ||||||||
| AuthorizedOfficialFirstName: | JONI | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3304175810 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | OH | Y | Agencies | Case Management |
No ID Information.