Healthcare Provider Details

I. General information

NPI: 1992859052
Provider Name (Legal Business Name): MCCLOUD COMMUNITY SERVICES DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W. MINNESOTA AVE
MCCLOUD CA
96057
US

IV. Provider business mailing address

PO BOX 269110
SACRAMENTO CA
95826-9110
US

V. Phone/Fax

Practice location:
  • Phone: 530-964-2017
  • Fax: 530-964-3175
Mailing address:
  • Phone: 916-669-4607
  • Fax: 916-471-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: EMILY COULTER
Title or Position: FINANCE OFFICER
Credential:
Phone: 530-964-2017