=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902869092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELCOME AMBULANCE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2006
-----------------------------------------------------
Last Update Date | 12/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1631 LORETTA AVE UNIT 3
-----------------------------------------------------
City | FEASTERVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19053-7310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-750-0740
-----------------------------------------------------
Fax | 215-750-0564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 664 VALLEY STREAM CIR
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19053-1953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-750-0740
-----------------------------------------------------
Fax | 215-750-0564
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRESIDENT
-----------------------------------------------------
Name | MRS. OLGA LATYSHEVA
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 215-820-0584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 03091
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------