Provider Demographics
NPI:1295723658
Name:WASHINGTON COUNTY LIFE SAVING CREW INC
Entity type:Organization
Organization Name:WASHINGTON COUNTY LIFE SAVING CREW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-608-3941
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0065
Mailing Address - Country:US
Mailing Address - Phone:276-608-3941
Mailing Address - Fax:276-867-6622
Practice Address - Street 1:237 PARK ST SE
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3311
Practice Address - Country:US
Practice Address - Phone:276-676-2401
Practice Address - Fax:276-676-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295723658Medicaid
P00071239OtherRAILROAD MEDICARE
VA190000776Medicare PIN