Healthcare Provider Details

I. General information

NPI: 1912128075
Provider Name (Legal Business Name): EVESHAM TOWNSHIP FIRE DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 TUCKERTON RD
MARLTON NJ
08053-2652
US

IV. Provider business mailing address

984 TUCKERTON RD
EVESHAM NJ
08053-2652
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-2750
  • Fax:
Mailing address:
  • Phone: 856-983-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEVES00198
License Number StateNJ

VIII. Authorized Official

Name: MAUREEN MITCHELL
Title or Position: CEO
Credential:
Phone: 856-983-2750