Basic Information
| Provider Information | |||||||||
| NPI: | 1740478643 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE VILLAGE NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 SANDALWOOD DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430559233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407888850 | ||||||||
| FaxNumber: | 7407888851 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 SANDALWOOD DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430559233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407888850 | ||||||||
| FaxNumber: | 7407888851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2007 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7407888850 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW, LSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | S. 0031608 | OH | Y | Agencies | Case Management |
No ID Information.