Provider Demographics
NPI:1922640655
Name:SHIRLEY COMMUNITY AMBULANCE CORP
Entity Type:Organization
Organization Name:SHIRLEY COMMUNITY AMBULANCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUTCSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-399-5380
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-0072
Mailing Address - Country:US
Mailing Address - Phone:631-399-5380
Mailing Address - Fax:
Practice Address - Street 1:3 PLYMOUTH PL
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2265
Practice Address - Country:US
Practice Address - Phone:631-399-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport