Provider Demographics
NPI:1356448765
Name:ARCHBALD COMMUNITY AMBULANCE AND RESCUE SQUAD
Entity Type:Organization
Organization Name:ARCHBALD COMMUNITY AMBULANCE AND RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENTLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-5652
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-0001
Mailing Address - Country:US
Mailing Address - Phone:570-282-5652
Mailing Address - Fax:570-282-5653
Practice Address - Street 1:195 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-1903
Practice Address - Country:US
Practice Address - Phone:570-282-5652
Practice Address - Fax:570-282-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011579800004Medicaid
PA280295OtherBCNEPA/AC2
PA1157980OtherUNISON-THREE RIVERS
PA20017052OtherAMERIHEALTH MERCY
PA998524OtherBC/BS NEPA
PA069706OtherFIRST PRIORITY HEALTH
PA087558800OtherFEDERAL BLACK LUNG
PA590008655OtherRAILROAD MEDICARE
PA087558800OtherFEDERAL BLACK LUNG
PA0011579800004Medicaid