Organization
NORTHWEST TLD SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD LEE HAMRICK (CEO)
(419) 450-6092
Entity
Organization
Contact information
Practice address
2662 WOODVILLE RD, NORTHWOOD, OH 43619-1446
(419) 450-6092
Mailing address
2662 WOODVILLE RD, NORTHWOOD, OH 43619-1446
(419) 450-6092
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4807730
—
OH
Enumeration date
12/02/2014
Last updated
12/02/2014
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