Provider Demographics
NPI:1396035747
Name:CHARLOTTE COUNTY RESCUE SQUAD INC
Entity Type:Organization
Organization Name:CHARLOTTE COUNTY RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-736-0087
Mailing Address - Street 1:P.O. BOX 330
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23947-3909
Mailing Address - Country:US
Mailing Address - Phone:434-736-0087
Mailing Address - Fax:
Practice Address - Street 1:8300 GEORGE WASHINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23947-3909
Practice Address - Country:US
Practice Address - Phone:434-736-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport