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General NPI Number Information
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NPI Number | 1760534036
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Entity Type | Organization
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Legal Business Name | ONTARIO COUNTY ADVANCED LIFE SUPPORT, INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 233 N PEARL ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1439
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Country | US
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Telephone | 585-396-6672
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Fax | 585-396-0154
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Provider Business Mailing Address
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Address Line | 350 PARRISH ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1731
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Country | US
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Telephone | 585-396-6672
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Fax | 585-396-0154
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Authorized Official
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Title or Position | CHIEF
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Name | MR. REGINALD ALLEN
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Credential |
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Telephone | 585-396-6672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 3496
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License Number State | NY
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