Provider Demographics
NPI:1275506164
Name:BLACK FOREST FIRE-RESCUE DISTRICT
Entity Type:Organization
Organization Name:BLACK FOREST FIRE-RESCUE DISTRICT
Other - Org Name:BLACK FOREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-495-4300
Mailing Address - Street 1:40813 TAPADERO CIR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-9215
Mailing Address - Country:US
Mailing Address - Phone:303-680-9860
Mailing Address - Fax:303-952-8075
Practice Address - Street 1:11445 TEACHOUT RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-6300
Practice Address - Country:US
Practice Address - Phone:719-495-4300
Practice Address - Fax:719-495-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO341600000X
CO2013-009341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06605232Medicaid
CO826590301OtherRAILROAD MEDICARE
CO06605232Medicaid