Healthcare Provider Details

I. General information

NPI: 1538133061
Provider Name (Legal Business Name): FIRE DISTRICT NO 21
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23014 70TH AVE E
GRAHAM WA
98338-9361
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-8811
  • Fax:
Mailing address:
  • Phone: 360-394-7020
  • Fax: 360-394-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number27D21
License Number StateWA

VIII. Authorized Official

Name: SANDI ROBERTS
Title or Position: CFO & DISTRICT SECRETARY
Credential:
Phone: 253-820-2981