Provider Demographics
NPI:1205917366
Name:CRANDON AREA RESCUE SQUAD, INC
Entity type:Organization
Organization Name:CRANDON AREA RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEELDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OKRASINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:715-478-3470
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-0302
Mailing Address - Country:US
Mailing Address - Phone:715-478-3470
Mailing Address - Fax:715-478-2745
Practice Address - Street 1:107 E. ELM ST
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-0302
Practice Address - Country:US
Practice Address - Phone:715-478-3470
Practice Address - Fax:715-478-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000999341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41328700Medicaid