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General NPI Number Information
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NPI Number | 1891056750
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Entity Type | Organization
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Legal Business Name | AMY SNEDEKER
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 68181 NEOLA AVENUE
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City | BRIDGEPORT
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State | OH
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Zip | 43912
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Country | US
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Telephone | 740-296-3099
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Fax |
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Provider Business Mailing Address
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Address Line | 68181 NEOLA AVENUE
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City | BRIDGEPORT
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State | OH
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Zip | 43912
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Country | US
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Telephone | 740-296-3099
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Fax |
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Authorized Official
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Title or Position | RN
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Name | AMY SNEDEKER
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Credential |
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Telephone | 740-296-3099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 320595
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License Number State | OH
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