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General NPI Number Information
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NPI Number | 1730325341
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Entity Type | Organization
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Legal Business Name | EASTFALLS AMBULANCE LLC
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Dates
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Enumeration Date | 01/02/2009
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Last Update Date | 01/02/2009
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Provider Practice Location Address
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Address Line | 5398 WYNNEFIELD AVE SUITE 105
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2344
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Country | US
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Telephone | 215-252-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 5398 WYNNEFIELD AVE SUITE 105
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2344
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Country | US
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Telephone | 215-877-3800
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. DAVETTE LAKISH CAMPBELL
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Credential |
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Telephone | 215-252-0169
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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 | 463715
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License Number State | PA
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