Provider Demographics
NPI:1801892013
Name:GLEN DALE VOL. FIRE DEPT, INC.
Entity type:Organization
Organization Name:GLEN DALE VOL. FIRE DEPT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-845-8800
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-522-7533
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:402 WHEELING AVE.
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038
Practice Address - Country:US
Practice Address - Phone:304-845-8800
Practice Address - Fax:304-845-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
WVWVEMS341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV590013702OtherRAILROAD MEDICARE
WV0144885000Medicaid
WV590013702OtherRAILROAD MEDICARE