1861573438 NPI number — HOMEDALE RURAL FIRE PROTECTION DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861573438 NPI number — HOMEDALE RURAL FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMEDALE RURAL FIRE PROTECTION DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861573438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6116 GRAYE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALDWELL
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83607-8072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-795-6930
Provider Business Mailing Address Fax Number:
208-795-6931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 WEST COLORADO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMEDALE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-482-4662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
URANGA RYSKA
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
AMBULANCE ADMINISTRATOR
Authorized Official Telephone Number:
208-337-3546

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  5302 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E0211 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010014554 . This is a "BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002874400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".