Provider Demographics
NPI:1154461374
Name:CITY OF ASHTABULA OHIO
Entity Type:Organization
Organization Name:CITY OF ASHTABULA OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-992-7123
Mailing Address - Street 1:4717 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6943
Mailing Address - Country:US
Mailing Address - Phone:440-992-7123
Mailing Address - Fax:440-992-7163
Practice Address - Street 1:4717 MAIN AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6943
Practice Address - Country:US
Practice Address - Phone:440-992-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0875496Medicaid
OH0875496Medicaid
OH600001947Medicare ID - Type UnspecifiedRAILROAD