1215150834 NPI number — LEVITTOWN-FAIRLESS HILLS RESCUE SQUAD INC

Table of content: (NPI 1215150834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215150834 NPI number — LEVITTOWN-FAIRLESS HILLS RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEVITTOWN-FAIRLESS HILLS RESCUE SQUAD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215150834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7405 NEW FALLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEVITTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19055-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-547-2822
Provider Business Mailing Address Fax Number:
215-946-6645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7405 NEW FALLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEVITTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19055-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-547-2822
Provider Business Practice Location Address Fax Number:
215-946-6645
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RENSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-547-2822

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  03319 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07985 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007007060005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0023639000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 46783 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 107626000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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