Basic Information
| Provider Information | |||||||||
| NPI: | 1245772177 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE VILLAGE NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 PLAZA DRIVE | ||||||||
| Address2: | |||||||||
| City: | ST CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405260204 | ||||||||
| FaxNumber: | 7405260207 | ||||||||
| Practice Location | |||||||||
| Address1: | 52 FOURTEENTH STREET | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405260204 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2016 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | GELLNER | ||||||||
| AuthorizedOfficialFirstName: | EVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7405260204 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LISW-S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | AP00940790 | WV | Y | Agencies | Community/Behavioral Health |
No ID Information.