Healthcare Provider Details

I. General information

NPI: 1053404145
Provider Name (Legal Business Name): EAST DEER VOLUNTEER HOSE CO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 FREEPORT RD
CREIGHTON PA
15030-1049
US

IV. Provider business mailing address

927 FREEPORT RD P O BOX 303
CREIGHTON PA
15030-1049
US

V. Phone/Fax

Practice location:
  • Phone: 724-468-1212
  • Fax:
Mailing address:
  • Phone: 724-468-1212
  • Fax: 724-468-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03247
License Number StatePA

VIII. Authorized Official

Name: LORI ROBINSON
Title or Position: CFO
Credential:
Phone: 724-468-1212