Provider Demographics
NPI:1699984732
Name:VILLAGE OF NAVARRE
Entity type:Organization
Organization Name:VILLAGE OF NAVARRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLERK/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-879-5508
Mailing Address - Street 1:27 CANAL ST W
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-1193
Mailing Address - Country:US
Mailing Address - Phone:330-879-5508
Mailing Address - Fax:330-879-3011
Practice Address - Street 1:99 CANAL ST W
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-1193
Practice Address - Country:US
Practice Address - Phone:330-879-5508
Practice Address - Fax:330-879-3011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLIAGE OF NAVARRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020667250341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00070553OtherRR MEDICARE
OH2442931Medicaid
OH2442931Medicaid