Provider Demographics
NPI:1871723155
Name:VILLAGE OF RARDEN
Entity type:Organization
Organization Name:VILLAGE OF RARDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMT
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-372-7245
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:888-709-4357
Mailing Address - Fax:937-619-3028
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:RARDEN
Practice Address - State:OH
Practice Address - Zip Code:45671-9041
Practice Address - Country:US
Practice Address - Phone:740-372-7245
Practice Address - Fax:740-372-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0203239003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========-00OtherOH BWC
=========002OtherMEDICAL MUTUAL
=========050OtherCARESOURCE
=========-00OtherOH BWC