Provider Demographics
NPI:1780893925
Name:UPPER CLEVELAND RESCUE SQUAD, INC.
Entity type:Organization
Organization Name:UPPER CLEVELAND RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-538-8520
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28090-0278
Mailing Address - Country:US
Mailing Address - Phone:704-538-7911
Mailing Address - Fax:980-368-0568
Practice Address - Street 1:1032 WEST STAGECOACH TRAIL
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:NC
Practice Address - Zip Code:28090
Practice Address - Country:US
Practice Address - Phone:704-538-7911
Practice Address - Fax:980-368-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406926Medicaid