Provider Demographics
NPI:1790775187
Name:JAFFREY-RINDGE MEMORIAL AMBULANCE INC
Entity Type:Organization
Organization Name:JAFFREY-RINDGE MEMORIAL AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-924-7797
Mailing Address - Street 1:1 PHOENIX MILL LN UNIT 200
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1445
Mailing Address - Country:US
Mailing Address - Phone:603-924-7797
Mailing Address - Fax:603-822-2813
Practice Address - Street 1:119 MAIN ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-6140
Practice Address - Country:US
Practice Address - Phone:603-532-6868
Practice Address - Fax:603-532-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0056341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30822415Medicaid
NHP00215540OtherRAILROAD MEDICARE
NHP00215540OtherRAILROAD MEDICARE