Provider Demographics
NPI:1164540183
Name:CANCER TREATMENT CENTER
Entity Type:Organization
Organization Name:CANCER TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CMPE
Authorized Official - Phone:330-262-6060
Mailing Address - Street 1:2376 BENDEN DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2570
Mailing Address - Country:US
Mailing Address - Phone:330-262-6060
Mailing Address - Fax:330-262-5572
Practice Address - Street 1:2376 BENDEN DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2570
Practice Address - Country:US
Practice Address - Phone:330-262-6060
Practice Address - Fax:330-262-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0406RT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty