Provider Demographics
NPI:1740230705
Name:HALIFAX COUNTY RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:HALIFAX COUNTY RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-572-3960
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592
Mailing Address - Country:US
Mailing Address - Phone:434-572-3960
Mailing Address - Fax:434-572-3969
Practice Address - Street 1:700 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592
Practice Address - Country:US
Practice Address - Phone:434-572-3960
Practice Address - Fax:434-572-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1693416L0300X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080055400OtherFED BLACK LUNG
VA590011516OtherRR M CARE
VA16164OtherOPTIMA
VA242223OtherANTHEM
VA009011773Medicaid
VA009011773Medicaid
VA080055400OtherFED BLACK LUNG