Provider Demographics
NPI:1740285758
Name:BLUE RIDGE MOUNTAIN VOLUNTEER FIRE & RESCUE SQUAD INC
Entity type:Organization
Organization Name:BLUE RIDGE MOUNTAIN VOLUNTEER FIRE & RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-794-2323
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-0726
Mailing Address - Country:US
Mailing Address - Phone:717-214-6018
Mailing Address - Fax:717-214-6020
Practice Address - Street 1:13063 MONTEREY LN
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:17214-9761
Practice Address - Country:US
Practice Address - Phone:717-794-2323
Practice Address - Fax:717-794-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001811666Medicaid
PA001811666Medicaid