Provider Demographics
NPI:1073646725
Name:INDEPENDENCE VOLUNTEER FIRE DEPT., INC.
Entity Type:Organization
Organization Name:INDEPENDENCE VOLUNTEER FIRE DEPT., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-878-2113
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:CA
Mailing Address - Zip Code:93526-0602
Mailing Address - Country:US
Mailing Address - Phone:760-878-2113
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH JACKSON STREET
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:CA
Practice Address - Zip Code:93526
Practice Address - Country:US
Practice Address - Phone:760-878-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00886FMedicaid
CAMTE00886FMedicaid