Healthcare Provider Details

I. General information

NPI: 1316911563
Provider Name (Legal Business Name): EAST GRAYS HARBOR FIRE AND RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 STAMPER ROAD
ELMA WA
98541
US

IV. Provider business mailing address

PO BOX 717
ELMA WA
98541-0717
US

V. Phone/Fax

Practice location:
  • Phone: 360-482-6266
  • Fax:
Mailing address:
  • Phone: 360-482-3143
  • Fax: 360-482-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number14D05
License Number StateWA

VIII. Authorized Official

Name: JODY ANN COON
Title or Position: ADMINISTRATIVE ASSISTANT CHIEF
Credential:
Phone: 360-482-4903