Provider Demographics
NPI: | 1265560759 |
---|---|
Name: | RECREATION UNLIMITED FARM & FUN |
Entity type: | Organization |
Organization Name: | RECREATION UNLIMITED FARM & FUN |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR & CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HUTTLIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 740-548-7006 |
Mailing Address - Street 1: | 7700 PIPER RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ASHLEY |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43003-9741 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 740-548-7006 |
Mailing Address - Fax: | 740-747-2640 |
Practice Address - Street 1: | 7700 PIPER RD |
Practice Address - Street 2: | |
Practice Address - City: | ASHLEY |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43003-9741 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-548-7006 |
Practice Address - Fax: | 740-747-2640 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-28 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2100612 | Medicaid |