Provider Demographics
NPI:1578748729
Name:NORTH COUNTY REGIONAL FIRE AUTHORITY
Entity Type:Organization
Organization Name:NORTH COUNTY REGIONAL FIRE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-652-1246
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 1:19727 MARINE DR
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-7879
Practice Address - Country:US
Practice Address - Phone:360-652-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9061532Medicaid
WA0229601OtherL&I AND CRIME VICTIMS
WAP0041739OtherRAILROAD MEDICARE
WA0229601OtherL&I AND CRIME VICTIMS