Provider Demographics
NPI:1508989856
Name:LONG VALLEY FIRE PROTECTION DIST
Entity Type:Organization
Organization Name:LONG VALLEY FIRE PROTECTION DIST
Other - Org Name:LAYTONVILLE FIRE DEPT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-984-6055
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:LAYTONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95454-0399
Mailing Address - Country:US
Mailing Address - Phone:707-984-6055
Mailing Address - Fax:707-984-6057
Practice Address - Street 1:44920 WILLIS RD
Practice Address - Street 2:
Practice Address - City:LAYTONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95454
Practice Address - Country:US
Practice Address - Phone:707-984-6055
Practice Address - Fax:707-984-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00229FMedicaid
CAMTE00229FMedicaid