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General NPI Number Information
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NPI Number | 1750966966
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Entity Type | Organization
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Legal Business Name | CEDAR CREEK CIVIL TOWNSHIP ALLEN CO
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 13415 STATE ST
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City | GRABILL
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State | IN
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Zip | 46741-2006
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Country | US
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Telephone | 260-627-5133
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Fax |
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Provider Business Mailing Address
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Address Line | 14110 PONY EXPRESS RUN
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City | LEO
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State | IN
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Zip | 46765-9423
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Country | US
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Telephone | 260-627-5695
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Fax | 260-627-5695
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Authorized Official
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Title or Position | TRUSTEEE
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Name | STEVEN P HERMAN
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Credential |
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Telephone | 260-627-5695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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