Provider Demographics
NPI:1689981110
Name:NORTHFIELD CENTER-SAGAMORE
Entity Type:Organization
Organization Name:NORTHFIELD CENTER-SAGAMORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE DISTRICT CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-467-7410
Mailing Address - Street 1:PO BOX 621005
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45262-1005
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:60 WEST AURORA ROAD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD CENTER
Practice Address - State:OH
Practice Address - Zip Code:44067
Practice Address - Country:US
Practice Address - Phone:330-467-7410
Practice Address - Fax:330-468-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000709999OtherANTHEM
8016014OtherAETNA
=========OtherHUMANA
000000709999OtherANTHEM