Provider Demographics
NPI:1275746752
Name:VILLAGE OF NORTH RANDALL
Entity Type:Organization
Organization Name:VILLAGE OF NORTH RANDALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-662-0430
Mailing Address - Street 1:21937 MILES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RANDALL
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4703
Mailing Address - Country:US
Mailing Address - Phone:216-662-0430
Mailing Address - Fax:216-587-9280
Practice Address - Street 1:21937 MILES RD
Practice Address - Street 2:
Practice Address - City:NORTH RANDALL
Practice Address - State:OH
Practice Address - Zip Code:44128-4703
Practice Address - Country:US
Practice Address - Phone:216-662-0430
Practice Address - Fax:216-587-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962598Medicaid
OH9264871Medicare ID - Type Unspecified