Healthcare Provider Details

I. General information

NPI: 1962476317
Provider Name (Legal Business Name): CITY OF LYNDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 4TH ST
LYNDEN WA
98264-1903
US

IV. Provider business mailing address

PO BOX 671
LYNDEN WA
98264-0671
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-4400
  • Fax:
Mailing address:
  • Phone: 360-654-4400
  • Fax: 360-354-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number37M07
License Number StateWA

VIII. Authorized Official

Name: SANDRA D'ALESSANDRO
Title or Position: SERVICE MANAGER
Credential:
Phone: 360-354-4400