Healthcare Provider Details

I. General information

NPI: 1679430920
Provider Name (Legal Business Name): COOL BRANCH VOLUNTEER RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 SMITH MOUNTAIN ROAD
PENHOOK VA
24137
US

IV. Provider business mailing address

PO BOX 54
PENHOOK VA
24137-0054
US

V. Phone/Fax

Practice location:
  • Phone: 434-927-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIFFANI MATHERLY
Title or Position: CAPTAIN
Credential:
Phone: 434-927-5050