Provider Demographics
NPI:1497824049
Name:CITIZENS HOSE COMPANY OF JERSEY SHORE
Entity Type:Organization
Organization Name:CITIZENS HOSE COMPANY OF JERSEY SHORE
Other - Org Name:JERSEY SHORE AREA EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-398-4790
Mailing Address - Street 1:1212 LOCUST ST
Mailing Address - Street 2:PO BOX 5086
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-1920
Mailing Address - Country:US
Mailing Address - Phone:570-398-7471
Mailing Address - Fax:570-398-3520
Practice Address - Street 1:1212 LOCUST ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1920
Practice Address - Country:US
Practice Address - Phone:570-398-7471
Practice Address - Fax:570-398-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146L00000X, 146N00000X
PA030123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011047800002Medicaid
PA0011047800002Medicaid