Healthcare Provider Details

I. General information

NPI: 1104853258
Provider Name (Legal Business Name): CHARLOTTE VOLUNTEER FIRE AND RESCUE SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/30/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 FERRY RD
CHARLOTTE VT
05445
US

IV. Provider business mailing address

PO BOX 85
CHARLOTTE VT
05445-0085
US

V. Phone/Fax

Practice location:
  • Phone: 802-425-3111
  • Fax: 802-425-3115
Mailing address:
  • Phone: 802-425-3111
  • Fax: 802-425-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0302
License Number StateVT

VIII. Authorized Official

Name: PATRICE MACHAVERN
Title or Position: BUSINESS OPERATIONS MANAGER
Credential:
Phone: 802-425-3111