Healthcare Provider Details

I. General information

NPI: 1790276806
Provider Name (Legal Business Name): HARRODS CREEK VOL FIRE DEPT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 US HIGHWAY 42
PROSPECT KY
40059
US

IV. Provider business mailing address

10361 SPARTAN DR
CINCINNATI OH
45215-1220
US

V. Phone/Fax

Practice location:
  • Phone: 502-228-1351
  • Fax:
Mailing address:
  • Phone: 800-962-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateKY

VIII. Authorized Official

Name: KEITH BROOKS
Title or Position: ASSISTANT CHIEF
Credential:
Phone: 502-228-1351