Provider Demographics
NPI:1528597200
Name:CENTRAL LIFESAVING AND RESCUE SQUAD
Entity Type:Organization
Organization Name:CENTRAL LIFESAVING AND RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-532-6015
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:GASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23857-0386
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5736 GASBURG ROAD
Practice Address - Street 2:
Practice Address - City:GASBURG
Practice Address - State:VA
Practice Address - Zip Code:23857-2385
Practice Address - Country:US
Practice Address - Phone:434-532-6015
Practice Address - Fax:434-532-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA164341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance