Provider Demographics
NPI:1194806257
Name:ENON VALLEY COMMUNITY VOLUNTEER FIRE DEPT. INC.
Entity type:Organization
Organization Name:ENON VALLEY COMMUNITY VOLUNTEER FIRE DEPT. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEAR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:724-336-4517
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:ENON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16120-0275
Mailing Address - Country:US
Mailing Address - Phone:724-336-4696
Mailing Address - Fax:724-336-3143
Practice Address - Street 1:95 CASS ST.
Practice Address - Street 2:
Practice Address - City:ENON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:16120-0275
Practice Address - Country:US
Practice Address - Phone:724-336-4696
Practice Address - Fax:724-336-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA052043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039382OtherGATEWAY
PA000902470002Medicaid
PA1039382OtherGATEWAY