Healthcare Provider Details

I. General information

NPI: 1164588927
Provider Name (Legal Business Name): VILLAGE OF MOGADORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S CLEVELAND AVE
MOGADORE OH
44260-1505
US

IV. Provider business mailing address

135 S CLEVELAND AVE
MOGADORE OH
44260-1505
US

V. Phone/Fax

Practice location:
  • Phone: 330-628-4896
  • Fax: 330-628-5850
Mailing address:
  • Phone: 330-628-5849
  • Fax: 330-628-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number020617900
License Number StateOH

VIII. Authorized Official

Name: JOHN M CAIN
Title or Position: CHIEF
Credential:
Phone: 330-628-5849