Healthcare Provider Details

I. General information

NPI: 1144350067
Provider Name (Legal Business Name): NORTH CRAWFORD RESCUE SQUAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LEGION DR.
SOLDIERS GROVE WI
54655-0037
US

IV. Provider business mailing address

102 LEGION DR. BOX 37
SOLDIERS GROVE WI
54655-0037
US

V. Phone/Fax

Practice location:
  • Phone: 608-624-5226
  • Fax: 608-624-5732
Mailing address:
  • Phone: 608-624-5226
  • Fax: 608-624-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number60-00994
License Number StateWI

VIII. Authorized Official

Name: MRS. BONNIE L. YOUNG
Title or Position: TREASIRER
Credential:
Phone: 608-624-5226