Provider Demographics
NPI:1457483679
Name:TOWN OF EATONVILLE
Entity Type:Organization
Organization Name:TOWN OF EATONVILLE
Other - Org Name:EATONVILLE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-832-6931
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:360-394-7030
Mailing Address - Fax:360-394-7097
Practice Address - Street 1:201 CENTER STREET W
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:360-832-6931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27MO53416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0191504OtherL&I AND CRIME VICTIMS
WA9045899Medicaid
WA9045899Medicaid