Healthcare Provider Details

I. General information

NPI: 1619017399
Provider Name (Legal Business Name): PORTAGE COUNTY AUDITOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 N CHESTNUT ST
RAVENNA OH
44266-3929
US

IV. Provider business mailing address

6831 N CHESTNUT ST
RAVENNA OH
44266-3929
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-4564
  • Fax: 330-298-4530
Mailing address:
  • Phone: 330-297-4564
  • Fax: 330-298-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0
License Number StateOH

VIII. Authorized Official

Name: MS. SUSAN M DOHERTY
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 330-297-4564