Provider Demographics
NPI:1609805563
Name:COUNTY RESCUE DBA CRA
Entity Type:Organization
Organization Name:COUNTY RESCUE DBA CRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:CROMWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-974-6000
Mailing Address - Street 1:2363 N BATAVIA ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2001
Mailing Address - Country:US
Mailing Address - Phone:714-974-6000
Mailing Address - Fax:714-882-7954
Practice Address - Street 1:2363 N BATAVIA ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-2001
Practice Address - Country:US
Practice Address - Phone:714-974-6000
Practice Address - Fax:714-882-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25747262341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01247FMedicaid
CAP00351755Medicare PIN
CAMTE01247FMedicaid
CAZZZ02598ZMedicare PIN