Provider Demographics
NPI:1508820994
Name:FAIR HAVEN VOLUNTEER RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:FAIR HAVEN VOLUNTEER RESCUE SQUAD, INC
Other - Org Name:FAIR HAVEN RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-265-3620
Mailing Address - Street 1:17 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:VT
Mailing Address - Zip Code:05743-1220
Mailing Address - Country:US
Mailing Address - Phone:802-265-3620
Mailing Address - Fax:802-265-8804
Practice Address - Street 1:17 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:VT
Practice Address - Zip Code:05743-1220
Practice Address - Country:US
Practice Address - Phone:802-265-3620
Practice Address - Fax:802-265-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1004341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT590006228Medicaid
NY01655861Medicaid
VT590006228Medicaid