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General NPI Number Information
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NPI Number | 1780893925
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Entity Type | Organization
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Legal Business Name | UPPER CLEVELAND RESCUE SQUAD, INC.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 1032 WEST STAGECOACH TRAIL
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City | LAWNDALE
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State | NC
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Zip | 28090
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Country | US
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Telephone | 704-538-7911
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Fax | 980-368-0568
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | LAWNDALE
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State | NC
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Zip | 28090-0278
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Country | US
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Telephone | 704-538-7911
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Fax | 980-368-0568
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. TROY KIESER
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Credential |
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Telephone | 704-538-8520
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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 | 1313
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License Number State | NC
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