Healthcare Provider Details

I. General information

NPI: 1861420929
Provider Name (Legal Business Name): LAKE MOHAVE RANCHOS FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16126 PIERCE FERRY RD.
DOLAN SPRINGS AZ
86441-0611
US

IV. Provider business mailing address

PO BOX 611
DOLAN SPRINGS AZ
86441-0611
US

V. Phone/Fax

Practice location:
  • Phone: 928-767-3300
  • Fax: 928-767-3301
Mailing address:
  • Phone: 928-767-3300
  • Fax: 928-767-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number07447537Z
License Number StateAZ

VIII. Authorized Official

Name: ELLEN REH
Title or Position: SECRETARY
Credential:
Phone: 928-767-3300