1790766467 NPI number — RICHMOND RESCUE INCORPORATED

Table of content: (NPI 1790766467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790766467 NPI number — RICHMOND RESCUE INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHMOND RESCUE INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790766467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05477-0404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-434-2394
Provider Business Mailing Address Fax Number:
802-329-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 RAILROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05477-0404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-434-2394
Provider Business Practice Location Address Fax Number:
802-329-2022
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHIARELLA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
802-434-2394

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 059-38339RICH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: OAM0056 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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