Healthcare Provider Details

I. General information

NPI: 1366858441
Provider Name (Legal Business Name): INDIAN VALLEY LOCAL SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N. WALNUT ST.
GNADENHUTTEN OH
44629
US

IV. Provider business mailing address

PO BOX 171 100 N. WALNUT ST.
GNADENHUTTEN OH
44629
US

V. Phone/Fax

Practice location:
  • Phone: 740-254-4334
  • Fax: 740-254-9271
Mailing address:
  • Phone: 740-254-4334
  • Fax: 740-254-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. G. IRA WENTWORTH
Title or Position: SUPERINTENDENT
Credential:
Phone: 740-254-4334