Provider Demographics
NPI:1386108710
Name:GREAT BROOK EMERGENCY MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:GREAT BROOK EMERGENCY MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:603-620-2650
Mailing Address - Street 1:340 COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275
Mailing Address - Country:US
Mailing Address - Phone:603-620-2650
Mailing Address - Fax:
Practice Address - Street 1:340 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275
Practice Address - Country:US
Practice Address - Phone:603-620-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance