Healthcare Provider Details

I. General information

NPI: 1336122514
Provider Name (Legal Business Name): CANTON RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 RIVERSIDE DR
CANTON NY
13617-1022
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-4613
  • Fax: 315-379-1360
Mailing address:
  • Phone: 315-635-1789
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number09523
License Number StateNY

VIII. Authorized Official

Name: MICHAEL DALTON
Title or Position: ASSISTANT TREASURER
Credential:
Phone: 315-386-4613