Basic Information
| Provider Information | |||||||||
| NPI: | 1558799007 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE VILLAGE NETWORK | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1162 JEFFERSON ST SE | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446637626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303089087 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 117 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | UHRICHSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446831818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409222144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2013 | ||||||||
| LastUpdateDate: | 10/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | WOOD | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | INDEPENDENT CONTRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 3303089087 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | S0013873 | OH | Y | Agencies | Case Management |
No ID Information.