Healthcare Provider Details

I. General information

NPI: 1093956286
Provider Name (Legal Business Name): GRAND ISLE RESCUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FAYWOOD ROAD
GRAND ISLE VT
05458
US

IV. Provider business mailing address

P.O. BOX 79
GRAND ISLE VT
05458
US

V. Phone/Fax

Practice location:
  • Phone: 802-372-3262
  • Fax: 802-372-3858
Mailing address:
  • Phone: 802-372-3330
  • Fax: 802-372-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0305
License Number StateVT

VIII. Authorized Official

Name: BRIAN WELSH
Title or Position: PRESIDENT
Credential:
Phone: 802-372-3330