Provider Demographics
NPI:1073594826
Name:NORTHERN GARRETT COUNTY RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:NORTHERN GARRETT COUNTY RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KABELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-746-8731
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-0293
Mailing Address - Country:US
Mailing Address - Phone:301-895-5520
Mailing Address - Fax:301-746-8991
Practice Address - Street 1:124 MILLER STREET
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-0293
Practice Address - Country:US
Practice Address - Phone:301-895-5520
Practice Address - Fax:301-746-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD793595ML1OtherOPTIMUM CHOICE
MHZ551OtherCAREFIRST
MD793595MD1OtherMDIPA
MD0450958OtherAETNA
MDDN97Medicare ID - Type Unspecified