Provider Demographics
NPI:1730118407
Name:LELAND VOLUNTEER FIRE-RESCUE DEPARTMENT INC
Entity Type:Organization
Organization Name:LELAND VOLUNTEER FIRE-RESCUE DEPARTMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-371-2727
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-0176
Mailing Address - Country:US
Mailing Address - Phone:910-371-2727
Mailing Address - Fax:910-371-1838
Practice Address - Street 1:1004 VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-0000
Practice Address - Country:US
Practice Address - Phone:910-371-2727
Practice Address - Fax:910-371-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406687Medicaid
NC2782506Medicare ID - Type Unspecified