Provider Demographics
NPI:1801817903
Name:COLONIAL BEACH RESCUE SQUAD INCORPORATED
Entity Type:Organization
Organization Name:COLONIAL BEACH RESCUE SQUAD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESCUE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-224-7750
Mailing Address - Street 1:225 DENNISON ST
Mailing Address - Street 2:
Mailing Address - City:COLONIAL BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:22443-2311
Mailing Address - Country:US
Mailing Address - Phone:804-224-7750
Mailing Address - Fax:
Practice Address - Street 1:225 DENNISON ST
Practice Address - Street 2:
Practice Address - City:COLONIAL BEACH
Practice Address - State:VA
Practice Address - Zip Code:22443-2311
Practice Address - Country:US
Practice Address - Phone:804-224-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00280341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9010181Medicaid