1447398201 NPI number — SYLVAN LIEBLA AMERICAN LEGION POST 1363

Table of content: (NPI 1447398201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447398201 NPI number — SYLVAN LIEBLA AMERICAN LEGION POST 1363

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYLVAN LIEBLA AMERICAN LEGION POST 1363
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:
AMERICAN LEGION AMBULANCE SERVICE
Provider Other Organization Name Type Code:
5
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:
1447398201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16996
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14616-0996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-563-1112
Provider Business Mailing Address Fax Number:
585-434-3312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 COLLINS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDRED
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-557-8915
Provider Business Practice Location Address Fax Number:
845-557-8915
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PINE
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY, TREASURER, CAPTAIN
Authorized Official Telephone Number:
845-557-6989

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  5212 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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