Provider Demographics
NPI:1609072685
Name:MANZANOLA FIRST RESPONSE UNIT
Entity Type:Organization
Organization Name:MANZANOLA FIRST RESPONSE UNIT
Other - Org Name:MANZANOLA EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:710-462-5272
Mailing Address - Street 1:100 W. SOUTH RAILROAD
Mailing Address - Street 2:P.O. BOX 185
Mailing Address - City:MANZANOLA
Mailing Address - State:CO
Mailing Address - Zip Code:81058-0185
Mailing Address - Country:US
Mailing Address - Phone:719-462-5272
Mailing Address - Fax:
Practice Address - Street 1:100 W. SOUTH RAILROAD
Practice Address - Street 2:
Practice Address - City:MANZANOLA
Practice Address - State:CO
Practice Address - Zip Code:81058-0185
Practice Address - Country:US
Practice Address - Phone:719-462-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12559032Medicaid
CO12559032Medicaid