Provider Demographics
NPI:1609081033
Name:LAKE SHORE FIRE DEPARTMENT
Entity Type:Organization
Organization Name:LAKE SHORE FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-833-6508
Mailing Address - Street 1:5310 W LAKE RD
Mailing Address - Street 2:PO BOX 8566
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5310 W LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2869
Practice Address - Country:US
Practice Address - Phone:814-833-6508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04166341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance