Healthcare Provider Details

I. General information

NPI: 1609822246
Provider Name (Legal Business Name): MILLVILLE RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CEDAR ST
MILLVILLE NJ
08332-9415
US

IV. Provider business mailing address

PO BOX 576
MILLVILLE NJ
08332-0576
US

V. Phone/Fax

Practice location:
  • Phone: 856-825-5063
  • Fax: 856-825-4713
Mailing address:
  • Phone: 856-825-5063
  • Fax: 856-825-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberMILL00381
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN REDDEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 856-825-5063