1770660755 NPI number — LADIES AUXILIARY OF THE CLIFFORD TOWNSHIP VOLUNTEER FIRE COMPANY

Table of content: (NPI 1770660755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770660755 NPI number — LADIES AUXILIARY OF THE CLIFFORD TOWNSHIP VOLUNTEER FIRE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LADIES AUXILIARY OF THE CLIFFORD TOWNSHIP VOLUNTEER FIRE COMPANY
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:
1770660755
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:
PO BOX 92
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18413-0092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-222-3741
Provider Business Mailing Address Fax Number:
570-222-2508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STATE ROUTE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18413-9800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-222-3741
Provider Business Practice Location Address Fax Number:
570-222-2508
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEFAZIO
Authorized Official First Name:
ELLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-222-3741

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  05081 , 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: 7619023 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 800408 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008070140002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0008070140002 . This is a "UNISON-THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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