Provider Demographics
NPI:1467434258
Name:FAITHORN RESCUE SQUAD
Entity Type:Organization
Organization Name:FAITHORN RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:906-438-2252
Mailing Address - Street 1:N14020 COUNTY ROAD 577
Mailing Address - Street 2:
Mailing Address - City:VULCAN
Mailing Address - State:MI
Mailing Address - Zip Code:49892-9656
Mailing Address - Country:US
Mailing Address - Phone:906-438-2252
Mailing Address - Fax:906-438-2252
Practice Address - Street 1:N15705 COUNTY ROAD 577
Practice Address - Street 2:
Practice Address - City:VULCAN
Practice Address - State:MI
Practice Address - Zip Code:49892-9517
Practice Address - Country:US
Practice Address - Phone:906-438-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI085428251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3005421Medicaid
MI3005421Medicaid