Provider Demographics
NPI:1194725853
Name:HONESDALE VOLUNTEER AMBULANCE CORPS INC
Entity type:Organization
Organization Name:HONESDALE VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-253-2911
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-0071
Mailing Address - Country:US
Mailing Address - Phone:570-253-2911
Mailing Address - Fax:570-253-2917
Practice Address - Street 1:12TH STREET @ INDUSTRIAL POINT
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-0071
Practice Address - Country:US
Practice Address - Phone:570-253-2911
Practice Address - Fax:570-253-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04034341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00779214Medicaid
PA078698OtherFIRST PRIORITY HEALTH
PA998539OtherBLUE CROSS OF NEPA
PA998539OtherBLUE CROSS OF NEPA