Provider Demographics
NPI:1003879529
Name:SCHAEFER AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:SCHAEFER AMBULANCE SERVICE, INC.
Other - Org Name:GOLD CROSS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-468-1612
Mailing Address - Street 1:905 S IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3721
Mailing Address - Country:US
Mailing Address - Phone:760-959-9980
Mailing Address - Fax:760-959-2645
Practice Address - Street 1:905 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3721
Practice Address - Country:US
Practice Address - Phone:760-959-9980
Practice Address - Fax:760-959-2645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHAEFER AMBULANCE SERVICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71633ZMedicaid
CA=========OtherFEDERAL TAX ID NUMBER
CAZZZ71633ZMedicaid