MEDICARE: VILLAGE NETWORK

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	13684	OH
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center	0342	OH
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	0342	OH
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	13686	OH
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	13685	OH
6	251V00000X	Voluntary or Charitable Agency	0342	OH
7	320800000X	Mental Illness Community Based Residential Treatment Facility	0342	OH
8	251V00000X	Voluntary or Charitable Agency

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1124057914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE NETWORK

Provider Business Mailing Address
First Line	:	2000 NOBLE DR
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-5353
Country	:	US
Telephone Number	:	330-264-3232
Fax Number	:	330-202-3880

Provider Business Practice Location Address
First Line	:	2000 NOBLE DR
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-5353
Country	:	US
Telephone Number	:	330-264-3232
Fax Number	:	330-202-3880

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	CHERYL S RODMAN
Credential	:
Telephone Number	:	330-439-8492

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	11/03/2025