=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316340185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE HANDS AMBULANCE TRANSPORT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2014
-----------------------------------------------------
Last Update Date | 10/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 CHERAW ST
-----------------------------------------------------
City | BENNETTSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29512-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-862-1727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 167 COXE RD E
-----------------------------------------------------
City | BLENHEIM
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29516-7927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. LARRY DAVIS CUTCHIN JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-862-1727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------