Basic Information
| Provider Information | |||||||||
| NPI: | 1619465853 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAFFREY-RINDGE MEMORIAL AMBULANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 MIDDLE WINCHENDON RD | ||||||||
| Address2: | |||||||||
| City: | RINDGE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034615636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038996187 | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | JAFFREY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034526140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035326868 | ||||||||
| FaxNumber: | 6035322405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2018 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | LAFORTUNE | ||||||||
| AuthorizedOfficialFirstName: | DONA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT,BOARD OF DIRECTORS | ||||||||
| AuthorizedOfficialTelephone: | 6038996187 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | NH | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | S3421548 | 05 | NH | MEDICAID |