Provider Demographics
NPI:1730286162
Name:FOREST CITY AREA VOLUNTEER AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:FOREST CITY AREA VOLUNTEER AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:570-785-5025
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18421-0151
Mailing Address - Country:US
Mailing Address - Phone:570-785-5025
Mailing Address - Fax:570-785-2369
Practice Address - Street 1:345 DELAWARE STREET REAR
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421-1403
Practice Address - Country:US
Practice Address - Phone:570-785-5025
Practice Address - Fax:570-785-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA043093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075242OtherFIRST PRIORITY HEALTH
PA30447OtherGEISINGER HEALTH PLAN
PA0007657830002OtherUNISON -THREE RIVERS
PA0007657830002Medicaid
PA288134Medicare ID - Type Unspecified