Provider Demographics
NPI:1245559640
Name:ROCKWELL FALLS AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:ROCKWELL FALLS AMBULANCE SERVICE INC
Other - Org Name:LUZERNE - HADLEY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-696-3289
Mailing Address - Street 1:107 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2200
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:518-391-2601
Practice Address - Street 1:35 LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKE LUZERNE
Practice Address - State:NY
Practice Address - Zip Code:12846-2323
Practice Address - Country:US
Practice Address - Phone:518-696-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13286341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance