Provider Demographics
NPI:1982738332
Name:HOOVERSVILLE RESCUE SQUAD, INC.
Entity type:Organization
Organization Name:HOOVERSVILLE RESCUE SQUAD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBOY
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:814-445-9628
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:HOOVERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15936-0213
Mailing Address - Country:US
Mailing Address - Phone:814-798-5109
Mailing Address - Fax:814-798-5109
Practice Address - Street 1:80 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOOVERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15936
Practice Address - Country:US
Practice Address - Phone:814-798-5109
Practice Address - Fax:814-798-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA56005146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty