Provider Demographics
NPI:1043218191
Name:SYCUAN TRIBAL GOVERNMENT
Entity Type:Organization
Organization Name:SYCUAN TRIBAL GOVERNMENT
Other - Org Name:SYCUAN FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-445-4564
Mailing Address - Street 1:2 KWAAYPAAY CT
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1832
Mailing Address - Country:US
Mailing Address - Phone:619-445-4564
Mailing Address - Fax:619-445-9764
Practice Address - Street 1:5449 SYCUAN RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1821
Practice Address - Country:US
Practice Address - Phone:619-445-4564
Practice Address - Fax:619-445-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00410FMedicaid
CAMTE00410FMedicaid