Provider Demographics
NPI:1699791020
Name:CLEVELAND TOWNSHIP VOLUNTEER FIRE DEPARTMENT INC
Entity type:Organization
Organization Name:CLEVELAND TOWNSHIP VOLUNTEER FIRE DEPARTMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRENTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-264-5443
Mailing Address - Street 1:29515 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-9513
Mailing Address - Country:US
Mailing Address - Phone:574-264-5443
Mailing Address - Fax:574-206-9483
Practice Address - Street 1:29515 COUNTY ROAD 6
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-9513
Practice Address - Country:US
Practice Address - Phone:574-264-5443
Practice Address - Fax:574-206-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN590014219OtherRR MEDICARE
IN200248450AMedicaid
IN000179156OtherANTHEM BCBS
IN590014219OtherRR MEDICARE
IN=========OtherTRICARE NORTH
IN164190Medicare PIN