Provider Demographics
NPI:1912045964
Name:WOODMERE VILLAGE
Entity Type:Organization
Organization Name:WOODMERE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:HOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-9511
Mailing Address - Street 1:27899 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4427
Mailing Address - Country:US
Mailing Address - Phone:216-831-9511
Mailing Address - Fax:216-292-7033
Practice Address - Street 1:27899 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-831-9511
Practice Address - Fax:216-292-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2247269Medicaid
OH2247269Medicaid