Healthcare Provider Details

I. General information

NPI: 1013142629
Provider Name (Legal Business Name): SANDY VALLEY LOCAL SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5362 STATE ROUTE 183 NE
MAGNOLIA OH
44643-8481
US

IV. Provider business mailing address

5362 STATE ROUTE 183 NE
MAGNOLIA OH
44643-8481
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-3613
  • Fax: 330-866-5238
Mailing address:
  • Phone: 330-866-3613
  • Fax: 330-866-5238

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: PAUL LATTAVO
Title or Position: TREASURER
Credential:
Phone: 330-866-3613