Healthcare Provider Details

I. General information

NPI: 1285792846
Provider Name (Legal Business Name): VILLAGE OF GENEVA ON THE LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4964 S SPENCER DR
GENEVA OH
44041-9715
US

IV. Provider business mailing address

4964 S SPENCER DR
GENEVA OH
44041-9715
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-8197
  • Fax: 440-466-8911
Mailing address:
  • Phone: 440-466-8197
  • Fax: 440-466-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. KIMBERLEY A. OSBORNE
Title or Position: FISCAL OFFICER
Credential:
Phone: 440-466-8197