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General NPI Number Information
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NPI Number | 1457478075
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Entity Type | Organization
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Legal Business Name | LAKE HAVASU FIRE DISTRICT
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 148808 HAVASU LAKE RD
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City | LAKE HAVASU
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State | CA
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Zip | 92363
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Country | US
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Telephone | 760-858-4395
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Fax |
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Provider Business Mailing Address
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Address Line | 157 W 5TH ST FL 2
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-1012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | PAT DENNEN
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Credential |
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Telephone | 909-387-6158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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