Provider Demographics
NPI:1588665467
Name:BEAVERTOWN RESCUE HOSE CO.
Entity Type:Organization
Organization Name:BEAVERTOWN RESCUE HOSE CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-658-7147
Mailing Address - Street 1:P.O. BOX 265
Mailing Address - Street 2:
Mailing Address - City:BEAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17813-0265
Mailing Address - Country:US
Mailing Address - Phone:570-658-7147
Mailing Address - Fax:570-658-8217
Practice Address - Street 1:222 SASSAFRAS AVE.
Practice Address - Street 2:
Practice Address - City:BEAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:17813-9796
Practice Address - Country:US
Practice Address - Phone:570-658-7147
Practice Address - Fax:570-658-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590000537OtherRAILROAD MEDICARE
PA001056261Medicaid
PA00105.62610001Medicaid
PA00105.62610001Medicaid