Provider Demographics
NPI:1689663726
Name:WAYNE TOWNSHIP BOARD OF TRUSTEES
Entity type:Organization
Organization Name:WAYNE TOWNSHIP BOARD OF TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-625-6212
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 1:6306 STATE ROUTE 133
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9516
Practice Address - Country:US
Practice Address - Phone:513-625-6212
Practice Address - Fax:513-625-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2103039Medicaid
OH286510001OtherCARESOURCE
OH000000011785OtherANTHEM BCBS
OH=========002OtherMEDICAL MUTUAL OF OHIO
OH2103039Medicaid
OH=========OtherTRICARE 4 LIFE
OH2103039Medicaid