Provider Demographics
NPI:1578520318
Name:LEFT BEAVER CIVIL DEFENSE & RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:LEFT BEAVER CIVIL DEFENSE & RESCUE SQUAD, INC.
Other - Org Name:LEFT BEAVER RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-377-6643
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:MCDOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647
Mailing Address - Country:US
Mailing Address - Phone:606-377-6643
Mailing Address - Fax:606-377-2888
Practice Address - Street 1:15990 KY HWY 122
Practice Address - Street 2:
Practice Address - City:HI HAT
Practice Address - State:KY
Practice Address - Zip Code:41636
Practice Address - Country:US
Practice Address - Phone:606-377-6643
Practice Address - Fax:606-377-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56005457Medicaid
OH2588650Medicaid
KY55036065Medicaid
KY089857100OtherBLACK LUNG
KY590008357OtherRAILROAD MEDICARE
KY000000070497OtherBLUE CROSS BLUE SHIELD
KY1264125OtherUNITED MINE WORKERS
KY56005457Medicaid