Provider Demographics
NPI:1609055896
Name:SUGARLOAF COMMUNITY RESCUE &
Entity Type:Organization
Organization Name:SUGARLOAF COMMUNITY RESCUE &
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:570-925-5824
Mailing Address - Street 1:987 ELK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-7404
Mailing Address - Country:US
Mailing Address - Phone:570-925-6070
Mailing Address - Fax:570-925-6070
Practice Address - Street 1:987 ELK GROVE RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814-7404
Practice Address - Country:US
Practice Address - Phone:570-925-6070
Practice Address - Fax:570-925-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024805150001Medicaid
PA181762Medicare PIN