Provider Demographics
NPI:1962642520
Name:VILLAGE OF MANCHESTER
Entity Type:Organization
Organization Name:VILLAGE OF MANCHESTER
Other - Org Name:MANCHESTER FIRE DEPARTMENT AND RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:CHANE
Authorized Official - Last Name:STRIBLEN KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-503-9710
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-224-4744
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:405 E. 5TH ST.
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144
Practice Address - Country:US
Practice Address - Phone:937-549-3358
Practice Address - Fax:937-549-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000622255OtherANTHEM
OH2961595Medicaid
000000622255OtherANTHEM