Healthcare Provider Details

I. General information

NPI: 1497824049
Provider Name (Legal Business Name): CITIZENS HOSE COMPANY OF JERSEY SHORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 LOCUST ST
JERSEY SHORE PA
17740-1920
US

IV. Provider business mailing address

1212 LOCUST ST PO BOX 5086
JERSEY SHORE PA
17740-1920
US

V. Phone/Fax

Practice location:
  • Phone: 570-398-7471
  • Fax: 570-398-3520
Mailing address:
  • Phone: 570-398-7471
  • Fax: 570-398-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03012
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CASSITY RAE HORNBERGER
Title or Position: OFFICE MANAGER
Credential: OFFICE
Phone: 570-398-7471