Provider Demographics
NPI:1568418820
Name:BROAD AND GALES CREEK RESCUE SQUAD
Entity Type:Organization
Organization Name:BROAD AND GALES CREEK RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-726-7373
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0193
Mailing Address - Country:US
Mailing Address - Phone:866-981-5886
Mailing Address - Fax:866-981-5886
Practice Address - Street 1:3010 HWY 24
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-5083
Practice Address - Country:US
Practice Address - Phone:252-726-7373
Practice Address - Fax:252-726-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406729Medicaid
NC3406729Medicaid