Provider Demographics
NPI:1588730626
Name:PRAIRIE TOWNSHIP TRUSTEES
Entity type:Organization
Organization Name:PRAIRIE TOWNSHIP TRUSTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:A.
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-279-2522
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:HOLMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44633-0245
Mailing Address - Country:US
Mailing Address - Phone:330-279-3112
Mailing Address - Fax:
Practice Address - Street 1:118 EAST JACKSON STREET
Practice Address - Street 2:
Practice Address - City:HOLMESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44633
Practice Address - Country:US
Practice Address - Phone:330-279-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE TOWNSHIP TRUSTEES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020370900341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020370900OtherBOARD OF PHARMACY
OH0915264Medicaid
OH=========00OtherBWC
OH0915264Medicaid