Provider Demographics
NPI:1417069790
Name:CANAAN TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:CANAAN TOWNSHIP TRUSTEES
Other - Org Name:CANAAN TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-435-0112
Mailing Address - Street 1:PO BOX 2223
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-2223
Mailing Address - Country:US
Mailing Address - Phone:330-435-0112
Mailing Address - Fax:
Practice Address - Street 1:209 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:OH
Practice Address - Zip Code:44217-9400
Practice Address - Country:US
Practice Address - Phone:330-435-6566
Practice Address - Fax:330-435-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021770500341600000X
OH020925300341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH228571Medicaid
OH590014652OtherRR MEDICARE
OH000000155963OtherBCBS
OH000000155963OtherBCBS
OH=========001OtherMEDMUTUAL
OH=========OtherTRICARE
OH=========00OtherBWC