Provider Demographics
NPI:1194814335
Name:KENOSHA COUNTY SCOUT LEADERS RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:KENOSHA COUNTY SCOUT LEADERS RESCUE SQUAD, INC
Other - Org Name:SCOUT LEADERS RESCUE SQUAD, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-694-7789
Mailing Address - Street 1:PO BOX 11430
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-0430
Mailing Address - Country:US
Mailing Address - Phone:414-962-9070
Mailing Address - Fax:414-962-9050
Practice Address - Street 1:3003 45TH STREET
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:262-694-7789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000282341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41359700Medicaid