Provider Demographics
NPI:1083672794
Name:BASELINE AMBULANCE
Entity Type:Organization
Organization Name:BASELINE AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMODEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-5911
Mailing Address - Street 1:13440 DAMAR DR
Mailing Address - Street 2:R-16
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1817
Mailing Address - Country:US
Mailing Address - Phone:215-464-5911
Mailing Address - Fax:
Practice Address - Street 1:13440 DAMAR DR
Practice Address - Street 2:R-16
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1817
Practice Address - Country:US
Practice Address - Phone:215-464-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport