# CRAIG BEACH VILLAGE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CRAIG BEACH VILLAGE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1689402109
- **Legal business name:** CRAIG BEACH VILLAGE
- **Authorized official:** MRS. PATRICIA A HAMMOND (FISCAL OFFICER)
- **Authorized official phone:** (330) 654-2107

## Contact information

- **Practice address:** 1797 GRANDVIEW RD, LAKE MILTON, OH 44429
- **Practice address phone:** (330) 654-2107
- **Practice address fax:** (330) 654-4157
- **Mailing address:** PO BOX 99, LAKE MILTON, OH 44429-0099
- **Mailing address phone:** (330) 654-2107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 07/25/2024
- **Last updated:** 04/17/2025