Provider Demographics
NPI:1326129966
Name:PENACOOK CIVIL DEFENSE RESCUE SQUAD
Entity Type:Organization
Organization Name:PENACOOK CIVIL DEFENSE RESCUE SQUAD
Other - Org Name:PENACOOK RESCUE SQUAD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMT-I
Authorized Official - Phone:603-753-1142
Mailing Address - Street 1:1 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BOSCAWEN
Mailing Address - State:NH
Mailing Address - Zip Code:03303-1211
Mailing Address - Country:US
Mailing Address - Phone:603-753-1142
Mailing Address - Fax:603-753-8792
Practice Address - Street 1:1 OAK ST
Practice Address - Street 2:
Practice Address - City:BOSCAWEN
Practice Address - State:NH
Practice Address - Zip Code:03303-1211
Practice Address - Country:US
Practice Address - Phone:603-753-1142
Practice Address - Fax:603-753-8792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
7100104Y0NH01OtherANTHEM
NH30010435Medicaid
NHAM0022Medicare PIN