Healthcare Provider Details

I. General information

NPI: 1508989856
Provider Name (Legal Business Name): LONG VALLEY FIRE PROTECTION DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44920 WILLIS RD
LAYTONVILLE CA
95454
US

IV. Provider business mailing address

PO BOX 399
LAYTONVILLE CA
95454-0399
US

V. Phone/Fax

Practice location:
  • Phone: 707-984-6055
  • Fax: 707-984-6057
Mailing address:
  • Phone: 707-984-6055
  • Fax: 707-984-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES LITTLE
Title or Position: FIRE CHIEF
Credential:
Phone: 707-984-6055