Provider Demographics
NPI:1003913443
Name:VALLEY GROVE VOLUNTEER FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:VALLEY GROVE VOLUNTEER FIRE DEPARTMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-547-0347
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:VALLEY GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26060
Mailing Address - Country:US
Mailing Address - Phone:304-547-0347
Mailing Address - Fax:304-547-1085
Practice Address - Street 1:355 FIREHOUSE LANE
Practice Address - Street 2:
Practice Address - City:VALLEY GROVE
Practice Address - State:WV
Practice Address - Zip Code:26060
Practice Address - Country:US
Practice Address - Phone:304-547-0347
Practice Address - Fax:304-547-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV027014341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
N7431271OtherHEALTH PLAN OF UPPER OHIO
WV0144562000Medicaid
WV001705486OtherMOUNTAIN STATE BCBS
WA=========00OtherWV COMPENSATION
WV001705486OtherMOUNTAIN STATE BCBS
WV0144562000Medicaid