Provider Demographics
NPI:1053671297
Name:ECHOING HILLS VILLAGE, INC.
Entity Type:Organization
Organization Name:ECHOING HILLS VILLAGE, INC.
Other - Org Name:CAMP ECHOING HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-327-2311
Mailing Address - Street 1:36272 COUNTY ROAD 79
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844-9770
Mailing Address - Country:US
Mailing Address - Phone:740-327-2311
Mailing Address - Fax:740-327-6371
Practice Address - Street 1:36272 COUNTY ROAD 79
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:OH
Practice Address - Zip Code:43844-9770
Practice Address - Country:US
Practice Address - Phone:740-327-2311
Practice Address - Fax:740-327-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1600477OtherDODD CONTRACT NUMBER
OH2394841Medicaid