Provider Demographics
NPI:1861509408
Name:HAMMONTON RESCUE SQUAD INC
Entity type:Organization
Organization Name:HAMMONTON RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:KACZMARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MICP
Authorized Official - Phone:609-561-0220
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-0604
Mailing Address - Country:US
Mailing Address - Phone:609-561-0220
Mailing Address - Fax:609-561-2158
Practice Address - Street 1:300 S EGG HARBOR ROAD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1416
Practice Address - Country:US
Practice Address - Phone:609-561-0220
Practice Address - Fax:609-561-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHAMM00247341600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
28954OtherUNIVERSITY HEALTH PLANS
33480OtherHEALTH PARTNERS
0500521000OtherAMERIHEALTH
0973009OtherAETNA USHC
NJ32798OtherAMERIGROUP NEW JERSEY
NJ7420404Medicaid
NJ1077588OtherHORIZON NJ HEALTH
NJ1077588OtherHORIZON NJ HEALTH
NJ7420404Medicaid