Provider Demographics
NPI:1518910421
Name:GRANT CTY FIRE PROTECCT DIST
Entity Type:Organization
Organization Name:GRANT CTY FIRE PROTECCT DIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-765-3175
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80034-0526
Mailing Address - Country:US
Mailing Address - Phone:509-765-3175
Mailing Address - Fax:509-765-3550
Practice Address - Street 1:11058 NELSON RD NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-8812
Practice Address - Country:US
Practice Address - Phone:509-765-3175
Practice Address - Fax:509-765-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13M18341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA163229OtherDEPT OF LABOR & INDUSTRY
WA9053257Medicaid
WA9053257Medicaid