Healthcare Provider Details

I. General information

NPI: 1497895163
Provider Name (Legal Business Name): LAUREL FIRE DEPARTMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 10TH ST
LAUREL DE
19956-1910
US

IV. Provider business mailing address

PO BOX 375
SMYRNA DE
19977-0375
US

V. Phone/Fax

Practice location:
  • Phone: 302-653-3557
  • Fax: 302-653-3552
Mailing address:
  • Phone: 302-653-3557
  • Fax: 302-653-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberA-81 B-81 C-81
License Number StateDE

VIII. Authorized Official

Name: MISS SHERRI LYNN BROUGH
Title or Position: ADMINISTRATOR
Credential:
Phone: 302-653-3557