1689981110 NPI number — NORTHFIELD CENTER-SAGAMORE

Table of content: (NPI 1689981110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689981110 NPI number — NORTHFIELD CENTER-SAGAMORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHFIELD CENTER-SAGAMORE
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:
1689981110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 621005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45262-1005
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:
60 WEST AURORA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFIELD CENTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-467-7410
Provider Business Practice Location Address Fax Number:
330-468-6576
Provider Enumeration Date:
09/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HETZEL
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
FIRE DISTRICT CLERK
Authorized Official Telephone Number:
330-467-7410

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000709999 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8016014 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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