Provider Demographics
NPI:1871562686
Name:DALMATIA AREA AMBULANCE LEAGUE
Entity type:Organization
Organization Name:DALMATIA AREA AMBULANCE LEAGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STARK-KERSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-758-8511
Mailing Address - Street 1:134 LINE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:PA
Mailing Address - Zip Code:17830-7326
Mailing Address - Country:US
Mailing Address - Phone:570-758-8511
Mailing Address - Fax:
Practice Address - Street 1:134 LINE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:PA
Practice Address - Zip Code:17830-7326
Practice Address - Country:US
Practice Address - Phone:570-758-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016169040001Medicaid
PA1016169040001Medicaid
PA280906Medicare PIN