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General NPI Number Information
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NPI Number | 1174547657
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Entity Type | Organization
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Legal Business Name | LADOGA RESCUE, INC.
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1025 E. MAIN ST.
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City | LADOGA
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State | IN
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Zip | 47954-9999
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Country | US
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Telephone | 765-942-2580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 266
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City | LADOGA
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State | IN
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Zip | 47954-0266
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Country | US
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Telephone | 765-942-2580
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHAEL HUNLEY
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Credential |
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Telephone | 765-942-2580
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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 | 0499
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License Number State | IN
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