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General NPI Number Information
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NPI Number | 1588665467
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Entity Type | Organization
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Legal Business Name | BEAVERTOWN RESCUE HOSE CO.
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 222 SASSAFRAS AVE.
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City | BEAVERTOWN
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State | PA
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Zip | 17813-9796
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Country | US
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Telephone | 570-658-7147
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Fax | 570-658-8217
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Provider Business Mailing Address
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Address Line | P.O. BOX 265
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City | BEAVERTOWN
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State | PA
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Zip | 17813-0265
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Country | US
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Telephone | 570-658-7147
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Fax | 570-658-8217
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Authorized Official
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Title or Position | EMS CAPTAIN
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Name | STEPHANIE L. THOMAS
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Credential |
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Telephone | 570-658-7147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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