Provider Demographics
NPI:1619567005
Name:GLEN LYN VOLUNTEER FIRE AND RESCUE
Entity Type:Organization
Organization Name:GLEN LYN VOLUNTEER FIRE AND RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAREWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-599-1905
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:
Practice Address - Street 1:300 EAST RIVER MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:GLEN LYN
Practice Address - State:VA
Practice Address - Zip Code:24093
Practice Address - Country:US
Practice Address - Phone:540-599-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport