Healthcare Provider Details

I. General information

NPI: 1356448765
Provider Name (Legal Business Name): ARCHBALD COMMUNITY AMBULANCE AND RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 DELAWARE ST
ARCHBALD PA
18403-1903
US

IV. Provider business mailing address

PO BOX 1
ARCHBALD PA
18403-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-5652
  • Fax: 570-282-5653
Mailing address:
  • Phone: 570-282-5652
  • Fax: 570-282-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number04151
License Number StatePA

VIII. Authorized Official

Name: MR. JOHN TRENTLY
Title or Position: SECRETARY
Credential:
Phone: 570-282-5652