Provider Demographics
NPI:1114430998
Name:ARCATA-MAD RIVER AMBULANCE LLC
Entity Type:Organization
Organization Name:ARCATA-MAD RIVER AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 742464
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2464
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:220 F ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6616
Practice Address - Country:US
Practice Address - Phone:707-822-3353
Practice Address - Fax:707-822-9628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCATA-MAD RIVER AMBULANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance