Provider Demographics
NPI:1518910827
Name:COTTAGE HOSE AMBULANCE CORP INC
Entity Type:Organization
Organization Name:COTTAGE HOSE AMBULANCE CORP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-5654
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0331
Mailing Address - Country:US
Mailing Address - Phone:570-282-4649
Mailing Address - Fax:570-282-5653
Practice Address - Street 1:2 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2833
Practice Address - Country:US
Practice Address - Phone:570-282-4649
Practice Address - Fax:570-282-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072995OtherFIRST PRIORITY HEALTH
PA1200740OtherPDA WAIVER PROGRAM
PA246774OtherBC NEPA ACCESSCARE 2
PA287142OtherSTERLING OPTION 1
PA246774OtherFERERAL EMPLOYEES CLAIMS
PA246774OtherFREDOM BLUE
PA1200740OtherHEALTHMATE
PA20013102OtherAMERI HEALTH MERCY
PAA1310245OtherOXFORD HEALTH PLAN
PA0012860OtherAETNA US HEALTHCARE
PA246774OtherBLUE CROSS BLUE CARD
PA287142OtherPRISON HEALTH SYSTEM
PA998502OtherBC MAJOR MEDICAL NEBC
PA1531307OtherGATEWAY HEALTH PLAN
PA0012007400001Medicaid
PA246774OtherBC BS SECURITY 65
PA1531307OtherGATEWAY HEALTH PLAN