Provider Demographics
NPI:1457887747
Name:CHESTERFIELD COUNTY RESCUE SQUAD INC. UNIT 2
Entity Type:Organization
Organization Name:CHESTERFIELD COUNTY RESCUE SQUAD INC. UNIT 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-ADVANCE
Authorized Official - Phone:843-910-1739
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-0147
Mailing Address - Country:US
Mailing Address - Phone:843-910-1739
Mailing Address - Fax:
Practice Address - Street 1:103 COTTON ST
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-1526
Practice Address - Country:US
Practice Address - Phone:843-910-1739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC081341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance