Healthcare Provider Details

I. General information

NPI: 1205156494
Provider Name (Legal Business Name): CHATHAM TOWNSHIP TTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6429 KOHLI DRIVE
SPENCER OH
44275-0057
US

IV. Provider business mailing address

P. O. BOX 99
SPENCER OH
44275-0099
US

V. Phone/Fax

Practice location:
  • Phone: 330-667-6020
  • Fax: 330-667-6020
Mailing address:
  • Phone: 330-667-6020
  • Fax: 330-667-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. CHARLES L. SIMAN
Title or Position: CHAIR TRUSTEE
Credential:
Phone: 330-667-2276