Provider Demographics
NPI:1750748448
Name:VILLAGE OF SUGARCREEK
Entity type:Organization
Organization Name:VILLAGE OF SUGARCREEK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-852-4112
Mailing Address - Street 1:410 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SUGARCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44681-9382
Mailing Address - Country:US
Mailing Address - Phone:330-852-4112
Mailing Address - Fax:330-852-2225
Practice Address - Street 1:152 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:SUGARCREEK
Practice Address - State:OH
Practice Address - Zip Code:44681
Practice Address - Country:US
Practice Address - Phone:330-852-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022559400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0167047Medicaid
OH022559400OtherBOARD OF PHARMACY