Provider Demographics
NPI:1134293798
Name:CHEROKEE RESCUE SQUAD
Entity Type:Organization
Organization Name:CHEROKEE RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-314-5878
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:AL
Mailing Address - Zip Code:35616-0241
Mailing Address - Country:US
Mailing Address - Phone:256-314-5878
Mailing Address - Fax:
Practice Address - Street 1:8020 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:AL
Practice Address - Zip Code:35616-4400
Practice Address - Country:US
Practice Address - Phone:256-314-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1573416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-11931OtherBLUE CROSS
AL51550582Medicaid