Provider Demographics
NPI:1427121011
Name:NIMISHILLEN TOWNSHIP TRUSTEES STARK COUNTY
Entity type:Organization
Organization Name:NIMISHILLEN TOWNSHIP TRUSTEES STARK COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-453-5880
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-0001
Mailing Address - Country:US
Mailing Address - Phone:330-453-5880
Mailing Address - Fax:330-453-5882
Practice Address - Street 1:4560 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-9370
Practice Address - Country:US
Practice Address - Phone:330-453-5880
Practice Address - Fax:330-453-5882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIMISHILLEN TOWNSHIP TRUSTEES STARK COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0304000341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020304002OtherBOARD OF PHARMACY
OH020304001OtherBOARD OF PHARMACY
OH0855007Medicaid
OH590007088OtherRRMEDICARE
OH020304000OtherBOARD OF PHARMACY