Provider Demographics
NPI:1922307644
Name:JACOBSTOWN VOLUNTEER FIRE COMPANY INC
Entity Type:Organization
Organization Name:JACOBSTOWN VOLUNTEER FIRE COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRONCUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-758-7386
Mailing Address - Street 1:PO BOX 868
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0868
Mailing Address - Country:US
Mailing Address - Phone:856-784-8004
Mailing Address - Fax:856-768-2739
Practice Address - Street 1:86 CHESTERFIELD JACOBSTOWN RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08562-1917
Practice Address - Country:US
Practice Address - Phone:609-758-7386
Practice Address - Fax:856-768-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJJ03130183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport