Provider Demographics
NPI:1609866094
Name:RAVENA RESCUE SQUAD INC
Entity Type:Organization
Organization Name:RAVENA RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNICAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-603-2455
Mailing Address - Street 1:107 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2231
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:
Practice Address - Street 1:1 BRUNO BLVD
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-1625
Practice Address - Country:US
Practice Address - Phone:518-756-2096
Practice Address - Fax:518-756-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
5900012637OtherRAILROAD MEDICARE
NY01903488Medicaid
NYBB3541Medicare PIN