Provider Demographics
NPI:1104214048
Name:THE VILLAGE NETWORK
Entity Type:Organization
Organization Name:THE VILLAGE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALISA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:614-253-8050
Mailing Address - Street 1:1751 E LONG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-2045
Mailing Address - Country:US
Mailing Address - Phone:614-253-8050
Mailing Address - Fax:
Practice Address - Street 1:1751 E LONG ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-2045
Practice Address - Country:US
Practice Address - Phone:614-253-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1450587320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness