Provider Demographics
NPI:1770628984
Name:FLEETWOOD VOL FIRE CO 1
Entity Type:Organization
Organization Name:FLEETWOOD VOL FIRE CO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-944-7676
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-0094
Mailing Address - Country:US
Mailing Address - Phone:610-944-7676
Mailing Address - Fax:610-944-7612
Practice Address - Street 1:16 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-1227
Practice Address - Country:US
Practice Address - Phone:610-944-7676
Practice Address - Fax:610-944-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018754110002Medicaid
PA0433013000OtherINDEPENDENCE BLUE CROSS
PA218385OtherHIGHMARK BLUE SHIELD
PA0018754110002Medicaid