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General NPI Number Information
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NPI Number | 1528597200
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Entity Type | Organization
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Legal Business Name | CENTRAL LIFESAVING AND RESCUE SQUAD
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 06/07/2017
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Provider Practice Location Address
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Address Line | 5736 GASBURG ROAD
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City | GASBURG
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State | VA
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Zip | 23857-2385
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Country | US
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Telephone | 434-532-6015
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Fax | 434-532-6015
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Provider Business Mailing Address
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Address Line | PO BOX 386
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City | GASBURG
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State | VA
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Zip | 23857-0386
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CAPTAIN
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Name | MR. WADE ALLEN RICHARDSON JR.
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Credential |
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Telephone | 434-532-6015
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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 | 164
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License Number State | VA
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