MEDICARE: FAIR HAVEN VOLUNTEER RESCUE SQUAD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	1004	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508820994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIR HAVEN VOLUNTEER RESCUE SQUAD, INC

Provider Business Mailing Address
First Line	:	17 PROSPECT ST
Second Line	:
City	:	FAIR HAVEN
State	:	VT
Zip	:	05743-1220
Country	:	US
Telephone Number	:	802-265-3620
Fax Number	:	802-265-8804

Provider Business Practice Location Address
First Line	:	17 PROSPECT ST
Second Line	:
City	:	FAIR HAVEN
State	:	VT
Zip	:	05743-1220
Country	:	US
Telephone Number	:	802-265-3620
Fax Number	:	802-265-8804

Authorized Official
Title or Position	:	MANAGER
Name	:	SEAN GALVIN
Credential	:
Telephone Number	:	802-265-3620

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	10/01/2021

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