Provider Demographics
NPI:1689751174
Name:RIVERSIDE VOL. FIRE DEPT.
Entity Type:Organization
Organization Name:RIVERSIDE VOL. FIRE DEPT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-288-1076
Mailing Address - Street 1:615 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3609
Mailing Address - Country:US
Mailing Address - Phone:814-288-1100
Mailing Address - Fax:814-487-7137
Practice Address - Street 1:615 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3609
Practice Address - Country:US
Practice Address - Phone:814-288-1100
Practice Address - Fax:814-487-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11034333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012277520004Medicaid
PA0012277520004Medicaid