Provider Demographics
NPI:1669994620
Name:KENT STATE UNIVERSITY
Entity type:Organization
Organization Name:KENT STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOLCHECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-672-8194
Mailing Address - Street 1:1500 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44242-0001
Mailing Address - Country:US
Mailing Address - Phone:330-672-8194
Mailing Address - Fax:330-672-3711
Practice Address - Street 1:350 MIDWAY DR MACC ANX RM 123
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-0001
Practice Address - Country:US
Practice Address - Phone:330-672-8426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENT STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation