Provider Demographics
NPI:1811952609
Name:RAVENNA CITY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:RAVENNA CITY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CECORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-297-2152
Mailing Address - Street 1:530 N FREEDOM ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2404
Mailing Address - Country:US
Mailing Address - Phone:330-297-2163
Mailing Address - Fax:330-296-4038
Practice Address - Street 1:530 N FREEDOM ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2404
Practice Address - Country:US
Practice Address - Phone:330-297-2163
Practice Address - Fax:330-296-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2538150Medicaid
OH2538150Medicaid