Provider Demographics
NPI:1528056991
Name:CHARLESTOWN AMBULANCE & RESCUE SERVICE, INC.
Entity type:Organization
Organization Name:CHARLESTOWN AMBULANCE & RESCUE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-364-3742
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-0346
Mailing Address - Country:US
Mailing Address - Phone:401-364-3742
Mailing Address - Fax:401-364-5438
Practice Address - Street 1:4891 OLD POST RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-1819
Practice Address - Country:US
Practice Address - Phone:401-364-3742
Practice Address - Fax:401-364-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009951Medicaid
590007904OtherRAILROAD MEDICARE
RI9009951Medicaid