Provider Demographics
NPI:1538847371
Name:DAVENPORT LIFE SAVING CREW INC
Entity type:Organization
Organization Name:DAVENPORT LIFE SAVING CREW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-202-9413
Mailing Address - Street 1:4033 COUNCIL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-4902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4014 HELEN HENDERSON HWY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:VA
Practice Address - Zip Code:24239-0000
Practice Address - Country:US
Practice Address - Phone:276-859-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport