Provider Demographics
NPI:1104042019
Name:WHITE HAVEN RESCUE UNIT, INC.
Entity Type:Organization
Organization Name:WHITE HAVEN RESCUE UNIT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-443-9499
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-0846
Mailing Address - Country:US
Mailing Address - Phone:570-714-3694
Mailing Address - Fax:570-714-3695
Practice Address - Street 1:500 TOWANDA ST # 502
Practice Address - Street 2:
Practice Address - City:WHITE HAVEN
Practice Address - State:PA
Practice Address - Zip Code:18661-1519
Practice Address - Country:US
Practice Address - Phone:570-443-9499
Practice Address - Fax:570-443-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050493416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA800423OtherFEDERAL BLACK LUNG
PA590008841OtherRAILROAD MEDICARE
PA0011031380002Medicaid
PA060409OtherFIRST PRIORITY HEALTH
PA060409OtherFIRST PRIORITY HEALTH