Provider Demographics
NPI:1508260126
Name:GLENVILLE AMBULANCE, LLC
Entity Type:Organization
Organization Name:GLENVILLE AMBULANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NRP
Authorized Official - Phone:443-744-3114
Mailing Address - Street 1:2414 CHAMBERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307-9548
Mailing Address - Country:US
Mailing Address - Phone:443-744-3114
Mailing Address - Fax:
Practice Address - Street 1:2414 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:BIGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17307-9548
Practice Address - Country:US
Practice Address - Phone:443-744-3114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA01013341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance