Provider Demographics
NPI:1114924206
Name:LAUDERDALE-LAGRANGE FIRE DEPARTMENT, INC.
Entity Type:Organization
Organization Name:LAUDERDALE-LAGRANGE FIRE DEPARTMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:262-495-4658
Mailing Address - Street 1:W6080 US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-4033
Mailing Address - Country:US
Mailing Address - Phone:262-495-4658
Mailing Address - Fax:262-495-4686
Practice Address - Street 1:W6080 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-4033
Practice Address - Country:US
Practice Address - Phone:262-495-8400
Practice Address - Fax:262-495-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-005223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport