Provider Demographics
NPI:1205824307
Name:ABBS VALLEY-BOISSEVAIN POCAHONTAS RESCUE SQUAD INC
Entity Type:Organization
Organization Name:ABBS VALLEY-BOISSEVAIN POCAHONTAS RESCUE SQUAD INC
Other - Org Name:RESCUE 945
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-452-8191
Mailing Address - Street 1:PO BOX 290184
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0184
Mailing Address - Country:US
Mailing Address - Phone:800-452-8191
Mailing Address - Fax:860-563-3403
Practice Address - Street 1:1289 BOISSEVAIN RD
Practice Address - Street 2:
Practice Address - City:BOISSEVAIN
Practice Address - State:VA
Practice Address - Zip Code:24606-0217
Practice Address - Country:US
Practice Address - Phone:276-945-2554
Practice Address - Fax:276-945-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA27341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205824307Medicaid
WV0144670000Medicaid
VA590000069Medicare PIN