Craig Beach Village
Organization Active NPI Land Ambulance · Lake Milton, OH
NPI 1689402109 · NPPES record last updated Apr 17, 2025
Key facts
- NPI
- 1689402109
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- CRAIG BEACH VILLAGE
- Practice address
- 1797 Grandview Rd
Lake Milton, OH 44429 - Phone
- (330) 654-2107
- Fax
- (330) 654-4157
- NPI assigned
- Jul 25, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- CRAIG BEACH VILLAGE
Authorized official
- Name
- Mrs. Patricia A Hammond
- Title
- Fiscal Officer
- Phone
- (330) 654-2107
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250418000478 | OH | Part B Supplier - Ambulance Service Supplier | 5890210223 | Practice locations: Lake Milton, OH |
National Provider Directory
- Part of
- Craig Beach Village
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
1797 Grandview Rd
Lake Milton, OH 44429
Mailing address
PO Box 99
Lake Milton, OH 44429-0099
Phone (330) 654-2107
Other providers in Lake Milton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.