Healthcare Provider Details

I. General information

NPI: 1780643148
Provider Name (Legal Business Name): GREENFIELD AREA LIFE SQUAD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 NORTH WASHINGTON ST
GREENFIELD OH
45123
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 937-981-3394
  • Fax:
Mailing address:
  • Phone: 800-875-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN MAYNARD
Title or Position: CHIEF
Credential:
Phone: 937-981-3394