Provider Demographics
NPI:1457478075
Name:LAKE HAVASU FIRE DISTRICT
Entity Type:Organization
Organization Name:LAKE HAVASU FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-387-6158
Mailing Address - Street 1:157 W 5TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:148808 HAVASU LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU
Practice Address - State:CA
Practice Address - Zip Code:92363
Practice Address - Country:US
Practice Address - Phone:760-858-4395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00974FMedicaid
CAZZZ14819ZMedicare PIN