Provider Demographics
NPI:1700388477
Name:BROOKS AMBULANCE INC.
Entity Type:Organization
Organization Name:BROOKS AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:NEALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-322-2124
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:ME
Mailing Address - Zip Code:04921-0066
Mailing Address - Country:US
Mailing Address - Phone:207-322-2124
Mailing Address - Fax:
Practice Address - Street 1:55 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:ME
Practice Address - Zip Code:04921-3637
Practice Address - Country:US
Practice Address - Phone:207-722-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME03803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport