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General NPI Number Information
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NPI Number | 1033184114
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Entity Type | Organization
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Legal Business Name | VERSAILLES VOLUNTEER LIFE RESCUE SQUAD, INC
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 220 W MAIN ST
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City | VERSAILLES
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State | OH
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Zip | 45380-1218
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Country | US
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Telephone | 937-526-4899
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Fax |
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Provider Business Mailing Address
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Address Line | 548 E WOOD ST
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City | VERSAILLES
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State | OH
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Zip | 45380-1450
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Country | US
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Telephone | 937-526-5714
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Fax | 937-526-5714
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RON DEMANGE
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Credential |
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Telephone | 937-526-5714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State | OH
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