Healthcare Provider Details

I. General information

NPI: 1215925763
Provider Name (Legal Business Name): ELLENVILLE FIRST AID & RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEBSTER ST
ELLENVILLE NY
12428-1109
US

IV. Provider business mailing address

PO BOX 207
ALLENTOWN PA
18105-0207
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-8181
  • Fax: 845-647-3947
Mailing address:
  • Phone: 484-664-2007
  • Fax: 484-664-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number5515
License Number StateNY

VIII. Authorized Official

Name: MR. STEVE GRUNDT
Title or Position: CHIEF
Credential:
Phone: 845-647-8181