Provider Demographics
NPI:1508994823
Name:SACRAMENTO VALLEY AMBULANCE INC.
Entity Type:Organization
Organization Name:SACRAMENTO VALLEY AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LAKICH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:916-422-3881
Mailing Address - Street 1:6220 BELLEAU WOOD LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-5922
Mailing Address - Country:US
Mailing Address - Phone:916-422-3881
Mailing Address - Fax:916-422-3866
Practice Address - Street 1:6220 BELLEAU WOOD LN
Practice Address - Street 2:SUITE 4
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-5922
Practice Address - Country:US
Practice Address - Phone:916-422-3881
Practice Address - Fax:916-422-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29323373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508994823Medicaid
CAZZZ05090ZMedicare PIN