Provider Demographics
NPI:1760565386
Name:VILLAGE OF BREWSTER
Entity Type:Organization
Organization Name:VILLAGE OF BREWSTER
Other - Org Name:VILLAGE OF BREWSTER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLUCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-767-4212
Mailing Address - Street 1:110 MAIN ST SE
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44613-1413
Mailing Address - Country:US
Mailing Address - Phone:330-767-4212
Mailing Address - Fax:330-767-3232
Practice Address - Street 1:110 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:OH
Practice Address - Zip Code:44613-1413
Practice Address - Country:US
Practice Address - Phone:330-767-4212
Practice Address - Fax:330-767-3232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF BREWSTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0384950341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
020384950OtherBOARD OF PHARMACY
P00192513OtherRR MEDICARE
OH2567762Medicaid
9349101Medicare PIN