Provider Demographics
NPI:1689876716
Name:AMPA COACH, INC.
Entity Type:Organization
Organization Name:AMPA COACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:RHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-355-3660
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:NY
Mailing Address - Zip Code:10933-0602
Mailing Address - Country:US
Mailing Address - Phone:845-355-3660
Mailing Address - Fax:845-355-3661
Practice Address - Street 1:405 COUNTY ROUTE 22
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-8439
Practice Address - Country:US
Practice Address - Phone:845-355-3660
Practice Address - Fax:845-355-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36463343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02679927Medicaid