Provider Demographics
NPI:1720130636
Name:FLORALA RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:FLORALA RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-858-2503
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-0133
Mailing Address - Country:US
Mailing Address - Phone:334-858-2503
Mailing Address - Fax:
Practice Address - Street 1:612 E 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-0000
Practice Address - Country:US
Practice Address - Phone:334-858-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000056297Medicaid
AL051056297OtherBLUE CROSS BLUE SHIELD AL
FL907928900Medicaid
AL051056297OtherBLUE CROSS BLUE SHIELD AL