Provider Demographics
NPI:1154321495
Name:LAKESHORE FIRE PROT DISTRICT
Entity Type:Organization
Organization Name:LAKESHORE FIRE PROT DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-994-2170
Mailing Address - Street 1:14815 OLYMPIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422
Mailing Address - Country:US
Mailing Address - Phone:707-994-2170
Mailing Address - Fax:707-994-4861
Practice Address - Street 1:14815 OLYMPIC DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-9522
Practice Address - Country:US
Practice Address - Phone:707-994-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
560013519OtherRRB
CAMTN00005FMedicaid
CAZZZ84448ZMedicare PIN