Provider Demographics
NPI:1770550816
Name:LAKE HARMONY RESCUE SQUAD AND AMBULANCE CORPS INC
Entity type:Organization
Organization Name:LAKE HARMONY RESCUE SQUAD AND AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-722-1782
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:LAKE HARMONY
Mailing Address - State:PA
Mailing Address - Zip Code:18624-0564
Mailing Address - Country:US
Mailing Address - Phone:570-722-1782
Mailing Address - Fax:570-722-4655
Practice Address - Street 1:105 LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE HARMONY
Practice Address - State:PA
Practice Address - Zip Code:18624
Practice Address - Country:US
Practice Address - Phone:570-722-1782
Practice Address - Fax:570-722-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590007092OtherRR MEDICARE
PA0012328970001Medicaid
PA207384Medicare PIN