Provider Demographics
NPI:1720129554
Name:GLADE SPRING VOLUNTEER LIFE SAVING CREW
Entity type:Organization
Organization Name:GLADE SPRING VOLUNTEER LIFE SAVING CREW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:THOMPSON
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-429-2584
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:GLADE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24340-0059
Mailing Address - Country:US
Mailing Address - Phone:276-429-5522
Mailing Address - Fax:276-429-5070
Practice Address - Street 1:412 E GLADE ST
Practice Address - Street 2:
Practice Address - City:GLADE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24340-0059
Practice Address - Country:US
Practice Address - Phone:276-429-5522
Practice Address - Fax:276-429-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA286341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance