1760740435 NPI number — DAN RIVER EMERGENCY SERVICES LLC

Table of content: (NPI 1760740435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760740435 NPI number — DAN RIVER EMERGENCY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAN RIVER EMERGENCY SERVICES LLC
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:
1760740435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3114 CROASDAILE DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-401-2386
Provider Business Mailing Address Fax Number:
919-425-0478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-2922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-401-2386
Provider Business Practice Location Address Fax Number:
919-425-0478
Provider Enumeration Date:
05/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BEHM
Authorized Official First Name:
TENNA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
469-401-2386

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com