Healthcare Provider Details

I. General information

NPI: 1306859558
Provider Name (Legal Business Name): CHIPPEWA TOWNSHIP TRUSTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14228 GALEHOUSE ROAD
DOYLESTOWN OH
44230
US

IV. Provider business mailing address

PO BOX 265
DOYLESTOWN OH
44230-0265
US

V. Phone/Fax

Practice location:
  • Phone: 330-658-2112
  • Fax: 330-658-3372
Mailing address:
  • Phone: 330-658-2112
  • Fax: 330-658-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number36-6000608
License Number StateOH

VIII. Authorized Official

Name: MS. DARLENE L SMITH
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 330-658-2112