Provider Demographics
NPI:1003854068
Name:GLENN DALE FIRE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:GLENN DALE FIRE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:AUGUSTA
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-805-2400
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-0249
Mailing Address - Country:US
Mailing Address - Phone:301-805-2400
Mailing Address - Fax:301-805-2438
Practice Address - Street 1:11900 GLENN DALE BLVD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9000
Practice Address - Country:US
Practice Address - Phone:301-805-2400
Practice Address - Fax:301-805-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD478SMedicare ID - Type UnspecifiedMEDICARE ID NUMBER