Provider Demographics
NPI:1528620911
Name:RC CHARLEY
Entity type:Organization
Organization Name:RC CHARLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RC
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-488-3942
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:PREWITT
Mailing Address - State:NM
Mailing Address - Zip Code:87045-0671
Mailing Address - Country:US
Mailing Address - Phone:505-488-3942
Mailing Address - Fax:
Practice Address - Street 1:57C PILLOW CREST RD
Practice Address - Street 2:
Practice Address - City:PREWITT
Practice Address - State:NM
Practice Address - Zip Code:87045
Practice Address - Country:US
Practice Address - Phone:505-488-3942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)