Provider Demographics
NPI:1588652325
Name:DEL NORTE COMMUNITY AMBULANCE, INC.
Entity Type:Organization
Organization Name:DEL NORTE COMMUNITY AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-657-0616
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-8413
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:560 PINE ST
Practice Address - Street 2:
Practice Address - City:DEL NORTE
Practice Address - State:CO
Practice Address - Zip Code:81132-2243
Practice Address - Country:US
Practice Address - Phone:719-657-0616
Practice Address - Fax:719-657-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO709855500OtherDOL - FECA / BL / ENERGY
CO9000157782Medicaid