Provider Demographics
NPI:1467495457
Name:PAMLICO COUNTY RESCUE SQUAD INC
Entity Type:Organization
Organization Name:PAMLICO COUNTY RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-745-3200
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-0302
Mailing Address - Country:US
Mailing Address - Phone:252-745-3200
Mailing Address - Fax:252-745-7883
Practice Address - Street 1:911 GRACE DANIELS RD
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515
Practice Address - Country:US
Practice Address - Phone:252-745-3200
Practice Address - Fax:252-745-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406770Medicaid
NC3406770Medicaid