Provider Demographics
NPI:1447398201
Name:SYLVAN LIEBLA AMERICAN LEGION POST 1363
Entity Type:Organization
Organization Name:SYLVAN LIEBLA AMERICAN LEGION POST 1363
Other - Org Name:AMERICAN LEGION AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY, TREASURER, CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:845-557-6989
Mailing Address - Street 1:PO BOX 16996
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-0996
Mailing Address - Country:US
Mailing Address - Phone:585-563-1112
Mailing Address - Fax:585-434-3312
Practice Address - Street 1:17 COLLINS ROAD
Practice Address - Street 2:
Practice Address - City:ELDRED
Practice Address - State:NY
Practice Address - Zip Code:12732
Practice Address - Country:US
Practice Address - Phone:845-557-8915
Practice Address - Fax:845-557-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5212251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable