Provider Demographics
NPI:1891056750
Name:AMY SNEDEKER
Entity Type:Organization
Organization Name:AMY SNEDEKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEDEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-296-3099
Mailing Address - Street 1:68181 NEOLA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912
Mailing Address - Country:US
Mailing Address - Phone:740-296-3099
Mailing Address - Fax:
Practice Address - Street 1:68181 NEOLA AVENUE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912
Practice Address - Country:US
Practice Address - Phone:740-296-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320595310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3100138Medicaid