Provider Demographics
NPI:1104853258
Name:CHARLOTTE VOLUNTEER FIRE AND RESCUE SERVICES INCORPORATED
Entity Type:Organization
Organization Name:CHARLOTTE VOLUNTEER FIRE AND RESCUE SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHAVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-425-3111
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-0085
Mailing Address - Country:US
Mailing Address - Phone:802-425-3111
Mailing Address - Fax:802-425-3115
Practice Address - Street 1:170 FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445
Practice Address - Country:US
Practice Address - Phone:802-425-3111
Practice Address - Fax:802-425-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT03023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTCHAR6413OtherBLUE CROSS
VT0AM0094Medicaid
VT0AM0094Medicaid