Provider Demographics
NPI:1306859558
Name:CHIPPEWA TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:CHIPPEWA TOWNSHIP TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-658-2112
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-0265
Mailing Address - Country:US
Mailing Address - Phone:330-658-2112
Mailing Address - Fax:330-658-3372
Practice Address - Street 1:14228 GALEHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230
Practice Address - Country:US
Practice Address - Phone:330-658-2112
Practice Address - Fax:330-658-3372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIPPEWA TOWNSHIP TRUSTEES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-15
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-60006083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0818100Medicaid
OHCH9242131Medicare ID - Type Unspecified