Provider Demographics
NPI:1629346358
Name:AGATE FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:AGATE FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-740-1989
Mailing Address - Street 1:40160 COUNTY ROAD 153
Mailing Address - Street 2:
Mailing Address - City:AGATE
Mailing Address - State:CO
Mailing Address - Zip Code:80101
Mailing Address - Country:US
Mailing Address - Phone:719-764-2771
Mailing Address - Fax:
Practice Address - Street 1:40160 COUNTY ROAD 153
Practice Address - Street 2:
Practice Address - City:AGATE
Practice Address - State:CO
Practice Address - Zip Code:80101
Practice Address - Country:US
Practice Address - Phone:719-764-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88371581Medicaid
CO88371581Medicaid