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General NPI Number Information
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NPI Number | 1770660755
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Entity Type | Organization
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Legal Business Name | LADIES AUXILIARY OF THE CLIFFORD TOWNSHIP VOLUNTEER FIRE COMPANY
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | STATE ROUTE 106
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City | CLIFFORD
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State | PA
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Zip | 18413-9800
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Country | US
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Telephone | 570-222-3741
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Fax | 570-222-2508
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Provider Business Mailing Address
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Address Line | PO BOX 92
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City | CLIFFORD
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State | PA
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Zip | 18413-0092
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Country | US
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Telephone | 571-222-3741
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Fax | 570-222-2508
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLIE DEFAZIO
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Credential |
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Telephone | 570-222-3741
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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 | 05081
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License Number State | PA
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