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General NPI Number Information
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NPI Number | 1871440529
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Entity Type | Organization
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Legal Business Name | SACRED GROUND
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Dates
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Enumeration Date | 03/12/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 5850 COUNTY HIGHWAY 77
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City | MILLERSBURG
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State | OH
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Zip | 44654
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Country | US
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Telephone | 330-403-9075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 321
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City | MOUNT EATON
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State | OH
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Zip | 44659-0321
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Country | US
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Telephone | 330-403-9075
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GRIFFIN LONG
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Credential | LISW
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Telephone | 330-403-9124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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