1629007455 NPI number — SHERWOOD VILLAGE

Table of content: (NPI 1629007455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629007455 NPI number — SHERWOOD VILLAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERWOOD VILLAGE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629007455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 392907
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-9907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-962-1484
Provider Business Mailing Address Fax Number:
513-772-4464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N HARRISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43556-8554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-962-1484
Provider Business Practice Location Address Fax Number:
513-772-4464
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROCK
Authorized Official First Name:
DARREL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
419-899-2145

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0540445 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "TRICARE 4 LIFE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "BUREAU OF WORKERS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000291972 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 590015252 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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