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General NPI Number Information
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NPI Number | 1619054913
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Entity Type | Organization
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Legal Business Name | CLEVELAND COUNTY LIFE SAVING AND RESCUE SQUAD INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 312 E PARKER ST
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-3025
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Country | US
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Telephone | 704-739-2077
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Fax | 704-739-2995
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Provider Business Mailing Address
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Address Line | 1324 SHELBY RD
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-2628
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Country | US
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Telephone | 704-739-2077
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Fax | 704-739-2995
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Authorized Official
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Title or Position | CAPTAIN
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Name | MR. JOHN W HARRIS JR.
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Credential |
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Telephone | 704-739-2077
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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 | NC
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