Basic Information
| Provider Information | |||||||||
| NPI: | 1548763022 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE VILLAGE NETWORK INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE VILLAGE NETWORK/BRITE FUTURES - WHEELING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 NOBLE DR | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446915353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302643232 | ||||||||
| FaxNumber: | 3302023880 | ||||||||
| Practice Location | |||||||||
| Address1: | 53 14TH ST STE 700 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260033423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405260204 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2018 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | CALLIHAN | ||||||||
| AuthorizedOfficialFirstName: | LOIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3302023860 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE VILLAGE NETWORK INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251V00000X | Y | Agencies | Voluntary or Charitable |
No ID Information.