Provider Demographics
NPI:1952331076
Name:CHESTNUT RIDGE AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:CHESTNUT RIDGE AMBULANCE ASSOCIATION
Other - Org Name:CHESTNUT RIDGE AMBULANCE ASSN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-839-2774
Mailing Address - Street 1:409 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1141
Mailing Address - Country:US
Mailing Address - Phone:724-887-6822
Mailing Address - Fax:724-887-9440
Practice Address - Street 1:4037 QUAKER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ALUM BANK
Practice Address - State:PA
Practice Address - Zip Code:15521-8250
Practice Address - Country:US
Practice Address - Phone:814-839-2774
Practice Address - Fax:814-839-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008440270002Medicaid
PA286644OtherBLUE CROSS/BLUE SHIELD
PA286644OtherBLUE CROSS/BLUE SHIELD