Provider Demographics
NPI:1518009513
Name:SILVER LAKE VOLUNTEER FIRE DEPARTMENT AND RESCUE
Entity Type:Organization
Organization Name:SILVER LAKE VOLUNTEER FIRE DEPARTMENT AND RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT COMMANDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:570-663-2102
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:BRACKNEY
Mailing Address - State:PA
Mailing Address - Zip Code:18812-0133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RR#1 QUAKER LAKE ROAD
Practice Address - Street 2:FIREMAN'S FIELD
Practice Address - City:BRACKNEY
Practice Address - State:PA
Practice Address - Zip Code:18812
Practice Address - Country:US
Practice Address - Phone:570-663-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040923416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065182Medicare ID - Type Unspecified