1215090410 NPI number — ECHOING HILLS VILLAGE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215090410 NPI number — ECHOING HILLS VILLAGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECHOING HILLS VILLAGE, INC.
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:
6
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:
1215090410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36272 COUNTY ROAD 79
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43844-9770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-327-2311
Provider Business Mailing Address Fax Number:
740-327-6371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH AMHERST
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44001-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-986-3085
Provider Business Practice Location Address Fax Number:
440-986-2013
Provider Enumeration Date:
12/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SWANSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
740-327-2311

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  4710629 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0902778 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9441 . This is a "OHIO DEPT OF HEATH NO." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".