Healthcare Provider Details

I. General information

NPI: 1164582953
Provider Name (Legal Business Name): ECHOING HILLS VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 BEVERLY AVE
CANAL FULTON OH
44614-9384
US

IV. Provider business mailing address

36272 COUNTY ROAD 79
WARSAW OH
43844-9770
US

V. Phone/Fax

Practice location:
  • Phone: 330-854-6621
  • Fax: 330-854-4326
Mailing address:
  • Phone: 740-327-2311
  • Fax: 740-327-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number7610231
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN R SWANSON
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 740-327-2311