Provider Demographics
NPI:1508876467
Name:ENTERPRISE RESCUE INC.
Entity Type:Organization
Organization Name:ENTERPRISE RESCUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURE
Authorized Official - Prefix:MR
Authorized Official - First Name:AVON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSARGE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-II
Authorized Official - Phone:334-347-0333
Mailing Address - Street 1:PO BOX 311190
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1190
Mailing Address - Country:US
Mailing Address - Phone:334-347-0333
Mailing Address - Fax:334-347-7666
Practice Address - Street 1:519 E LEE ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2284
Practice Address - Country:US
Practice Address - Phone:334-347-0333
Practice Address - Fax:334-347-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51050326OtherBCBS/AL