Provider Demographics
NPI:1194814335
Name:KENOSHA COUNTY SCOUT LEADERS RESCUE SQUAD, INC
Entity type:Organization
Organization Name:KENOSHA COUNTY SCOUT LEADERS RESCUE SQUAD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF - BOARD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KURHAJEC
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:262-652-2041
Mailing Address - Street 1:3019 45TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1647
Mailing Address - Country:US
Mailing Address - Phone:262-652-2041
Mailing Address - Fax:
Practice Address - Street 1:3019 45TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1647
Practice Address - Country:US
Practice Address - Phone:262-652-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
WI6000282341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41359700Medicaid