Healthcare Provider Details

I. General information

NPI: 1164412623
Provider Name (Legal Business Name): RED SPRINGS RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W 4TH AVE
RED SPRINGS NC
28377-1509
US

IV. Provider business mailing address

409 PORTER AVE
SCOTTDALE PA
15683-1141
US

V. Phone/Fax

Practice location:
  • Phone: 910-359-8078
  • Fax:
Mailing address:
  • Phone: 724-887-6822
  • Fax: 724-887-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1193
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1193
License Number StateNC

VIII. Authorized Official

Name: MR. JOSEPH WHITLEY
Title or Position: SECRETARY/TRESURER
Credential:
Phone: 910-359-8078