Provider Demographics
NPI:1740261775
Name:DEERFIELD VALLEY RESCUE, INC.
Entity type:Organization
Organization Name:DEERFIELD VALLEY RESCUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-464-5557
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-0854
Mailing Address - Country:US
Mailing Address - Phone:802-464-5557
Mailing Address - Fax:802-464-4728
Practice Address - Street 1:34 ROUTE 100 S
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:VT
Practice Address - Zip Code:05363-7944
Practice Address - Country:US
Practice Address - Phone:802-464-5557
Practice Address - Fax:802-464-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT12023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT000-6456Medicaid
VTVT6456OtherBC
VT000-6456Medicaid