Provider Demographics
NPI:1033184114
Name:VERSAILLES VOLUNTEER LIFE RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:VERSAILLES VOLUNTEER LIFE RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-526-5714
Mailing Address - Street 1:548 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-1450
Mailing Address - Country:US
Mailing Address - Phone:937-526-5714
Mailing Address - Fax:937-526-5714
Practice Address - Street 1:220 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-1218
Practice Address - Country:US
Practice Address - Phone:937-526-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000000975OtherBLUECROSS/BLUESHIELD
OH0973273Medicaid
OH000000000975OtherBLUECROSS/BLUESHIELD