Provider Demographics
NPI:1710044615
Name:SUFFIELD TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:SUFFIELD TOWNSHIP TRUSTEES
Other - Org Name:SUFFIELD TWP FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RASNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-628-9240
Mailing Address - Street 1:1256 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-9579
Mailing Address - Country:US
Mailing Address - Phone:330-628-9240
Mailing Address - Fax:330-628-5000
Practice Address - Street 1:1256 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-9579
Practice Address - Country:US
Practice Address - Phone:330-628-9240
Practice Address - Fax:330-628-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102687Medicaid
OH0102687Medicaid