Healthcare Provider Details

I. General information

NPI: 1861605818
Provider Name (Legal Business Name): WINDHAM TOWNSHIP TRUSTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9621 E CENTER ST
WINDHAM OH
44288-1010
US

IV. Provider business mailing address

9621 E CENTER ST P.O.BOX 344
WINDHAM OH
44288-1010
US

V. Phone/Fax

Practice location:
  • Phone: 330-326-2225
  • Fax: 330-326-2225
Mailing address:
  • Phone: 330-326-2225
  • Fax: 330-326-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number02-0849250-10827
License Number StateOH

VIII. Authorized Official

Name: MR. CLARENCE E SIMPSON SR.
Title or Position: FIRE CHIEF
Credential: EMT
Phone: 330-326-2225