Provider Demographics
NPI:1689479727
Name:COTTONWOOD RESCUE, INC
Entity type:Organization
Organization Name:COTTONWOOD RESCUE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATHERAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-790-2927
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:36320-0486
Mailing Address - Country:US
Mailing Address - Phone:334-691-5059
Mailing Address - Fax:
Practice Address - Street 1:57 GRANGER ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AL
Practice Address - Zip Code:36320-5218
Practice Address - Country:US
Practice Address - Phone:334-790-2927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance