Provider Demographics
NPI:1093821498
Name:TWIN LAKES VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD INC
Entity Type:Organization
Organization Name:TWIN LAKES VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD INC
Other - Org Name:TWIN LAKES VOL FD AND RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-877-2373
Mailing Address - Street 1:236 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9189
Mailing Address - Country:US
Mailing Address - Phone:262-877-2373
Mailing Address - Fax:262-877-9494
Practice Address - Street 1:236 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9198
Practice Address - Country:US
Practice Address - Phone:262-877-2373
Practice Address - Fax:262-877-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41359200Medicaid
WI41359200Medicaid