Provider Demographics
NPI:1841383551
Name:LATTA RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:LATTA RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-752-4402
Mailing Address - Street 1:107 WEST BAMBERGG STREET
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565
Mailing Address - Country:US
Mailing Address - Phone:843-752-4402
Mailing Address - Fax:
Practice Address - Street 1:107 WEST BAMBERGG STREET
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565
Practice Address - Country:US
Practice Address - Phone:843-752-4402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC093341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ328760001Medicaid
SCAB0201Medicaid