Provider Demographics
NPI:1356652960
Name:ELLSWORTH TOWNSHIP
Entity Type:Organization
Organization Name:ELLSWORTH TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STERNBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-538-3341
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44416-0123
Mailing Address - Country:US
Mailing Address - Phone:330-538-3341
Mailing Address - Fax:330-538-9615
Practice Address - Street 1:6036 S SALEM WARREN RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44416-9997
Practice Address - Country:US
Practice Address - Phone:330-538-3341
Practice Address - Fax:330-538-9615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTH TOWNSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-29
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9391461Medicare PIN