Healthcare Provider Details

I. General information

NPI: 1689479727
Provider Name (Legal Business Name): COTTONWOOD RESCUE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GRANGER ST
COTTONWOOD AL
36320-5218
US

IV. Provider business mailing address

PO BOX 486
COTTONWOOD AL
36320-0486
US

V. Phone/Fax

Practice location:
  • Phone: 334-790-2927
  • Fax:
Mailing address:
  • Phone: 334-691-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: BEAU DEATHERAGE
Title or Position: EMS DIRECTOR
Credential:
Phone: 334-790-2927