Provider Demographics
NPI:1427475854
Name:RAQUETTE LAKE VOLUNTEER AMBULANCE SQUAD INC
Entity type:Organization
Organization Name:RAQUETTE LAKE VOLUNTEER AMBULANCE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORKY
Authorized Official - Middle Name:
Authorized Official - Last Name:RISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-723-9041
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:RAQUETTE LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:13436-0125
Mailing Address - Country:US
Mailing Address - Phone:315-354-4644
Mailing Address - Fax:315-354-4228
Practice Address - Street 1:171 ROUTE 28
Practice Address - Street 2:
Practice Address - City:RAQUETTE LAKE
Practice Address - State:NY
Practice Address - Zip Code:13436-0125
Practice Address - Country:US
Practice Address - Phone:315-354-4644
Practice Address - Fax:315-354-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport