Healthcare Provider Details

I. General information

NPI: 1801892013
Provider Name (Legal Business Name): GLEN DALE VOL. FIRE DEPT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 WHEELING AVE.
GLEN DALE WV
26038
US

IV. Provider business mailing address

836 4TH AVENUE
HUNTINGTON WV
25701
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-8800
  • Fax: 304-845-3475
Mailing address:
  • Phone: 304-522-7533
  • Fax: 304-522-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberWVEMS
License Number StateWV

VIII. Authorized Official

Name: NORMAN PASTORIUS
Title or Position: CHIEF
Credential:
Phone: 304-845-8800