Provider Demographics
NPI:1427025238
Name:IVA RESCUE SQUAD
Entity type:Organization
Organization Name:IVA RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-348-6195
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:IVA
Mailing Address - State:SC
Mailing Address - Zip Code:29655
Mailing Address - Country:US
Mailing Address - Phone:864-348-6195
Mailing Address - Fax:864-348-7117
Practice Address - Street 1:9715 HIGHWAY 81 S
Practice Address - Street 2:
Practice Address - City:IVA
Practice Address - State:SC
Practice Address - Zip Code:29655
Practice Address - Country:US
Practice Address - Phone:864-348-6195
Practice Address - Fax:864-348-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0119Medicaid
SCAB0119Medicaid