Provider Demographics
NPI:1144460791
Name:GALLIA-VINTON EDUCATIONAL SERVICE CENTER
Entity type:Organization
Organization Name:GALLIA-VINTON EDUCATIONAL SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:740-245-0593
Mailing Address - Street 1:60 RIDGE AVENUE, ROOM 131, WOOD HALL
Mailing Address - Street 2:P.O. 178
Mailing Address - City:RIO GRANDE
Mailing Address - State:OH
Mailing Address - Zip Code:45674-0178
Mailing Address - Country:US
Mailing Address - Phone:740-245-0593
Mailing Address - Fax:740-245-0596
Practice Address - Street 1:60 RIDGE AVENUE, ROOM 131, WOOD HALL
Practice Address - Street 2:P.O. 178
Practice Address - City:RIO GRANDE
Practice Address - State:OH
Practice Address - Zip Code:45674-0178
Practice Address - Country:US
Practice Address - Phone:740-245-0593
Practice Address - Fax:740-245-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management