Healthcare Provider Details

I. General information

NPI: 1104980176
Provider Name (Legal Business Name): RUNNING BEAR RESCUE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRL SUITE F
SANTA FE NM
87505-4779
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-6269
  • Fax:
Mailing address:
  • Phone: 402-572-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberBR7078478
License Number StateNM

VIII. Authorized Official

Name: EDWARD LITTLE
Title or Position: OWNER
Credential:
Phone: 505-328-6269