Provider Demographics
NPI:1770660755
Name:LADIES AUXILIARY OF THE CLIFFORD TOWNSHIP VOLUNTEER FIRE COMPANY
Entity Type:Organization
Organization Name:LADIES AUXILIARY OF THE CLIFFORD TOWNSHIP VOLUNTEER FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-222-3741
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:CLIFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18413-0092
Mailing Address - Country:US
Mailing Address - Phone:571-222-3741
Mailing Address - Fax:570-222-2508
Practice Address - Street 1:STATE ROUTE 106
Practice Address - Street 2:
Practice Address - City:CLIFFORD
Practice Address - State:PA
Practice Address - Zip Code:18413-9800
Practice Address - Country:US
Practice Address - Phone:570-222-3741
Practice Address - Fax:570-222-2508
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
PA050813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7619023OtherCIGNA
PA800408OtherFIRST PRIORITY HEALTH
PA0008070140002Medicaid
PA0008070140002OtherUNISON-THREE RIVERS
PA0008070140002OtherUNISON-THREE RIVERS