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General NPI Number Information
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NPI Number | 1205917366
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Entity Type | Organization
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Legal Business Name | CRANDON AREA RESCUE SQUAD, INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 107 E. ELM ST
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City | CRANDON
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State | WI
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Zip | 54520-0302
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Country | US
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Telephone | 715-478-3470
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Fax | 715-478-2745
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Provider Business Mailing Address
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Address Line | PO BOX 302
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City | CRANDON
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State | WI
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Zip | 54520-0302
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Country | US
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Telephone | 715-478-3470
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Fax | 715-478-2745
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DEELDA J OKRASINSKI
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Credential | EMT
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Telephone | 715-478-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 6000999
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 6000999
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License Number State | WI
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