Provider Demographics
NPI:1982733218
Name:COMMUNITY CARE AMBULANCE NETWORK
Entity Type:Organization
Organization Name:COMMUNITY CARE AMBULANCE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EGELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-992-1401
Mailing Address - Street 1:115 E 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004
Mailing Address - Country:US
Mailing Address - Phone:440-992-1401
Mailing Address - Fax:440-992-6331
Practice Address - Street 1:115 E 24TH STREET
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004
Practice Address - Country:US
Practice Address - Phone:440-992-1401
Practice Address - Fax:440-992-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590008084OtherRAILROAD MEDICARE
OH000000155830OtherBLUE CROSS BLUE SHIELD
OH0972783Medicaid
OH0972783Medicaid