Healthcare Provider Details

I. General information

NPI: 1619394020
Provider Name (Legal Business Name): GARDEN VALLEY FIRE PROTECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 S. MIDDLE FORK RD.
GARDEN VALLEY ID
83622-0000
US

IV. Provider business mailing address

PO BOX 747
WHEELING IL
60090-0747
US

V. Phone/Fax

Practice location:
  • Phone: 208-462-3175
  • Fax: 208-462-3175
Mailing address:
  • Phone: 800-244-2345
  • Fax: 800-329-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JON DELVALLE
Title or Position: FIRE CHIEF
Credential:
Phone: 208-462-3175