Provider Demographics
NPI:1760055925
Name:LICKING TOWNSHIP
Entity Type:Organization
Organization Name:LICKING TOWNSHIP
Other - Org Name:LICKING TOWNSHIP TRUSTEES
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-323-0211
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:JACKSONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43030-0222
Mailing Address - Country:US
Mailing Address - Phone:740-323-0211
Mailing Address - Fax:740-323-0568
Practice Address - Street 1:9384 JACKSONTOWN RD
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-8803
Practice Address - Country:US
Practice Address - Phone:740-323-0211
Practice Address - Fax:740-323-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport