Healthcare Provider Details

I. General information

NPI: 1700990322
Provider Name (Legal Business Name): LAKES OF THE FOUR SEASONS VOLUNTEER FIRE FORCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W 275 S
HEBRON IN
46341-9712
US

IV. Provider business mailing address

745 W 275 S
HEBRON IN
46341-9712
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-7576
  • Fax: 219-662-1281
Mailing address:
  • Phone: 219-662-7576
  • Fax: 219-662-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0438
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0438
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0438
License Number StateIN

VIII. Authorized Official

Name: KEVIN HEEREMA
Title or Position: FIRE CHIEF
Credential:
Phone: 219-662-7576