Provider Demographics
NPI:1568712792
Name:PENN TOWNSHIP TTEE
Entity Type:Organization
Organization Name:PENN TOWNSHIP TTEE
Other - Org Name:PENN TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORTOLESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-532-6365
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-224-4474
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:13960 JACKSON RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9523
Practice Address - Country:US
Practice Address - Phone:574-904-5024
Practice Address - Fax:574-255-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport