Healthcare Provider Details

I. General information

NPI: 1861573438
Provider Name (Legal Business Name): HOMEDALE RURAL FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WEST COLORADO AVE
HOMEDALE ID
83628
US

IV. Provider business mailing address

6116 GRAYE LN
CALDWELL ID
83607-8072
US

V. Phone/Fax

Practice location:
  • Phone: 208-482-4662
  • Fax:
Mailing address:
  • Phone: 208-795-6930
  • Fax: 208-795-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number5302
License Number StateID

VIII. Authorized Official

Name: TERESA IRENE URANGA RYSKA
Title or Position: AMBULANCE ADMINISTRATOR
Credential:
Phone: 208-337-3546