=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396885554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GOOD-WILL FIRE COMPANY NO 1 OF NEW CASTLE DELAWARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 SOUTH ST
-----------------------------------------------------
City | HISTORIC NEW CASTLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19720-5056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-328-2211
-----------------------------------------------------
Fax | 302-328-2216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 PORTER AVE
-----------------------------------------------------
City | SCOTTDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15683-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-887-6822
-----------------------------------------------------
Fax | 724-887-9440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CAPTAIN
-----------------------------------------------------
Name | TIM MOORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-420-1008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 3656
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------