Provider Demographics
NPI:1245220706
Name:RENSSELAER FALLS VOLUNTEER RESCUE SQUAD INC
Entity Type:Organization
Organization Name:RENSSELAER FALLS VOLUNTEER RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-854-4855
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:424 RENSSELAER STREET
Practice Address - Street 2:
Practice Address - City:RENSSELAER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13680-3164
Practice Address - Country:US
Practice Address - Phone:315-323-2513
Practice Address - Fax:315-344-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31068341600000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01958254Medicaid
NY01958254Medicaid
NYP00214978OtherRAILROAD
NY01958254Medicaid