Healthcare Provider Details

I. General information

NPI: 1962642520
Provider Name (Legal Business Name): VILLAGE OF MANCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E. 5TH ST.
MANCHESTER OH
45144
US

IV. Provider business mailing address

PO BOX 2122
RIVERVIEW MI
48193-1122
US

V. Phone/Fax

Practice location:
  • Phone: 937-549-3358
  • Fax: 937-549-2502
Mailing address:
  • Phone: 734-224-4744
  • Fax: 734-479-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARLA CHANE STRIBLEN KIRK
Title or Position: CAPTAIN
Credential:
Phone: 513-503-9710