Provider Demographics
NPI:1619954914
Name:TOWN OF GILA BEND
Entity Type:Organization
Organization Name:TOWN OF GILA BEND
Other - Org Name:GILA BEND RESCUE/AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ARELIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-909-3644
Mailing Address - Street 1:PO BOX A
Mailing Address - Street 2:
Mailing Address - City:GILA BEND
Mailing Address - State:AZ
Mailing Address - Zip Code:85337-0019
Mailing Address - Country:US
Mailing Address - Phone:928-683-2255
Mailing Address - Fax:928-683-6430
Practice Address - Street 1:644 W PIMA
Practice Address - Street 2:
Practice Address - City:GILA BEND
Practice Address - State:AZ
Practice Address - Zip Code:85337
Practice Address - Country:US
Practice Address - Phone:928-683-2255
Practice Address - Fax:928-683-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ78341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071978Medicaid
AZ590014287OtherRR MEDICARE
AZAZ0152460OtherBCBS
AZ071978Medicaid
AZZ75836Medicare PIN