Provider Demographics
NPI:1326036203
Name:OLANCHA COMMUNITY SERVICE DISTRICT
Entity Type:Organization
Organization Name:OLANCHA COMMUNITY SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERKUYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-375-3776
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:OLANCHA
Mailing Address - State:CA
Mailing Address - Zip Code:93549-0064
Mailing Address - Country:US
Mailing Address - Phone:760-764-2370
Mailing Address - Fax:760-375-3746
Practice Address - Street 1:610 SHOP ST
Practice Address - Street 2:
Practice Address - City:OLANCHA
Practice Address - State:CA
Practice Address - Zip Code:93549
Practice Address - Country:US
Practice Address - Phone:760-764-2370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00957FMedicaid
CAZZZ31162ZMedicare ID - Type Unspecified