Provider Demographics
NPI:1740685809
Name:FAITHORN RESCUE SQUAD
Entity type:Organization
Organization Name:FAITHORN RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEVOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-438-2243
Mailing Address - Street 1:W8601 BLUM RD
Mailing Address - Street 2:
Mailing Address - City:VULCAN
Mailing Address - State:MI
Mailing Address - Zip Code:49892-9635
Mailing Address - Country:US
Mailing Address - Phone:906-438-2243
Mailing Address - Fax:
Practice Address - Street 1:W8601 BLUM RD
Practice Address - Street 2:
Practice Address - City:VULCAN
Practice Address - State:MI
Practice Address - Zip Code:49892-9635
Practice Address - Country:US
Practice Address - Phone:906-438-2243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8693093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1467434258Medicaid