Healthcare Provider Details

I. General information

NPI: 1760586994
Provider Name (Legal Business Name): CASCADE RURAL FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E PINE
CASCADE ID
83611
US

IV. Provider business mailing address

PO BOX 825
CASCADE ID
83611-0825
US

V. Phone/Fax

Practice location:
  • Phone: 208-630-3837
  • Fax:
Mailing address:
  • Phone: 208-382-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number#7410
License Number StateID

VIII. Authorized Official

Name: L KATHLEEN CAMMACK
Title or Position: BILLLING AGENT
Credential:
Phone: 208-337-4254