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General NPI Number Information
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NPI Number | 1134540503
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Entity Type | Organization
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Legal Business Name | THE VILLAGE NETWORK INC.
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 5500 MARKET ST STE 106
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City | BOARDMAN
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State | OH
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Zip | 44512-2616
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Country | US
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Telephone | 330-788-1155
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Fax | 330-788-1467
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Provider Business Mailing Address
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Address Line | 5500 MARKET ST STE 106
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City | BOARDMAN
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State | OH
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Zip | 44512-2616
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Country | US
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Telephone | 330-788-1155
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Fax | 330-788-1467
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. CHARLES ERIC BALDWIN
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Credential | MS, MSW, LSW
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Telephone | 330-788-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | S.0500644
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License Number State | OH
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