Healthcare Provider Details

I. General information

NPI: 1225165608
Provider Name (Legal Business Name): NORTHERN LOCAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SHERIDAN DR
THORNVILLE OH
43076-9757
US

IV. Provider business mailing address

8700 SHERIDAN DR
THORNVILLE OH
43076-9757
US

V. Phone/Fax

Practice location:
  • Phone: 740-743-1303
  • Fax: 740-743-3301
Mailing address:
  • Phone: 740-743-1303
  • Fax: 740-743-3301

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: MR. JACK E. PORTER
Title or Position: SUPERINTENDENT
Credential:
Phone: 740-743-1303