Provider Demographics
NPI:1801866702
Name:GRAHAMSVILLE FIRST AID SQUAD INC
Entity Type:Organization
Organization Name:GRAHAMSVILLE FIRST AID SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAHNKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-985-2839
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:499 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAHAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12740
Practice Address - Country:US
Practice Address - Phone:914-985-2331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09767341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
27870OtherGHI
NY01671521Medicaid
590012121OtherPALMETTO GBA RR MEDICARE
NY01671521Medicaid