Provider Demographics
NPI:1033183678
Name:THURSTON COUNTY FPD #11
Entity Type:Organization
Organization Name:THURSTON COUNTY FPD #11
Other - Org Name:LITTLEROCK FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:
Authorized Official - Last Name:KALEIWAHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-352-1614
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7030
Mailing Address - Fax:360-394-7097
Practice Address - Street 1:10828 LITTLEROCK RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-8525
Practice Address - Country:US
Practice Address - Phone:360-352-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34D113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0164585OtherL&I AND CRIME VICTIMS
WA9053158Medicaid
WA9113LIOtherREGENCE
OR181845Medicaid
WA590015352Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WAGAB32450Medicare PIN