Provider Demographics
NPI:1780637595
Name:THE CRIVITZ RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:THE CRIVITZ RESCUE SQUAD, INC
Other - Org Name:CRIVITZ RESCUE SQUAD, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARB
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-854-7666
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-0666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 HENRIETTE AVE
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-1536
Practice Address - Country:US
Practice Address - Phone:715-854-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41335200OtherHIRSP
WI41335200Medicaid
41335200OtherMANAGED HEALTH
WI0101OtherJOHN DEERE
25747OtherNETWORK HEALTH
WI41335200OtherHIRSP
WI0101OtherJOHN DEERE
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