Healthcare Provider Details

I. General information

NPI: 1205836095
Provider Name (Legal Business Name): SHAVERS FORK FIRE RESCUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 05/30/2025
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 RESCUE ROAD
SNOWSHOE WV
26209
US

IV. Provider business mailing address

PO BOX 388
SNOWSHOE WV
26209-0388
US

V. Phone/Fax

Practice location:
  • Phone: 304-572-3473
  • Fax: 304-572-2400
Mailing address:
  • Phone: 304-572-3473
  • Fax: 304-572-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANDON JONES
Title or Position: DIRECTOR OF EMS
Credential:
Phone: 304-661-8101