Provider Demographics
NPI:1043201908
Name:TOWN OF FAIRHAVEN
Entity Type:Organization
Organization Name:TOWN OF FAIRHAVEN
Other - Org Name:FAIRHAVEN FIRE AND EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-994-1428
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4043
Practice Address - Country:US
Practice Address - Phone:508-994-1428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3098341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000025528OtherBMC HEALTHNET PLAN
NY143050XXOtherPREFFERRED CARE
0008755OtherNEIGHBORHOOD HEALTH
MA1714252Medicaid
590006101OtherRR MEDICARE
700680OtherHARVARD PILGRIM
590006101OtherRR MEDICARE
MA089059Medicare ID - Type Unspecified