Healthcare Provider Details

I. General information

NPI: 1033184114
Provider Name (Legal Business Name): VERSAILLES VOLUNTEER LIFE RESCUE SQUAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W MAIN ST
VERSAILLES OH
45380-1218
US

IV. Provider business mailing address

548 E WOOD ST
VERSAILLES OH
45380-1450
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-4899
  • Fax:
Mailing address:
  • Phone: 937-526-5714
  • Fax: 937-526-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. RON DEMANGE
Title or Position: PRESIDENT
Credential:
Phone: 937-526-5714