Organization
BRISTOL VILLAGE HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY KUYOTH (VICE PRESIDENT)
(614) 451-2151
Entity
Organization
Contact information
Practice address
621 E 5TH ST, WAVERLY, OH 45690-1505
(740) 647-8670
(740) 947-8680
Mailing address
621 E 5TH ST, WAVERLY, OH 45690-1505
(740) 647-8670
(740) 947-8680
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0213254
—
OH
Enumeration date
05/23/2007
Last updated
11/27/2007
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