Provider Demographics
NPI:1427110576
Name:BRACEVILLE TOWNSHIP
Entity type:Organization
Organization Name:BRACEVILLE TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:330-872-0085
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:800 BRACEVILLE ROBINSON RD SW
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-9529
Practice Address - Country:US
Practice Address - Phone:330-898-7199
Practice Address - Fax:330-898-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779073Medicaid
000000155955OtherANTHEM
OH1544152Medicaid
OH=========-00OtherWORKERS COMP
OH1544152Medicaid
OH=========026Medicaid
OH=========026Medicaid
OH9235811Medicare PIN