Provider Demographics
NPI:1417404930
Name:COPALIS CROSSING FIRE DEPARTMENT
Entity Type:Organization
Organization Name:COPALIS CROSSING FIRE DEPARTMENT
Other - Org Name:GRAYS HARBOR FIRE DEPT 16
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-289-3227
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7010
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:1617 OCEAN BEACH RD
Practice Address - Street 2:
Practice Address - City:COPALIS CROSSING
Practice Address - State:WA
Practice Address - Zip Code:98536
Practice Address - Country:US
Practice Address - Phone:360-289-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14D163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8959983Medicare PIN