Healthcare Provider Details

I. General information

NPI: 1003934498
Provider Name (Legal Business Name): VILLAGE OF GNADENHUTTEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N WALNUT ST
GNADENHUTTEN OH
44629-0155
US

IV. Provider business mailing address

214 W 3RD ST
DOVER OH
44622-2965
US

V. Phone/Fax

Practice location:
  • Phone: 740-254-4307
  • Fax:
Mailing address:
  • Phone: 330-602-5180
  • Fax: 330-602-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number79-201
License Number StateOH

VIII. Authorized Official

Name: MS. KIM STULL
Title or Position: CLERK
Credential:
Phone: 740-254-4307